Job Description

The Provider Enrollment Specialist facilitates the application from a new provider through all stages in order to enroll the provider with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports.

• Conducts the enrollment process and maintains provider information in enrollment platform
• Adheres to deadlines and enrollment schedules by tracking files through all stages
• Communicates with providers, payers, MSOs, CVOs via email, phone, and mail.
• Helps the department move to paperless by centralizing all provider data gathered in software
• Maintains confidentiality and responsibility for all enrollment files through the process

Qualifications

• High School Diploma or GED
• At least 2 years provider enrollment experience including remote / work-from-home experience.
• Payer contract negotiation experience preferred.
• Intermediate to advanced skills in MS Office Suite, including Excel
• Proficiency in the use of e-mail and skilled in maneuvering through the internet using multiple search engines.
• Excellent professional, oral, and written communication
• Strong organizational skills with attention to detail
• Strong work ethic and ability to follow established timelines to complete tasks
• Willingness to establish and maintain effective work relationships with providers, payers, MSOs, CVOs, co-workers, supervisors, and managers
• Represent Contracting Providers in a competent and professional manner