FLSA Status: Non-Exempt
SUMMARY OF DUTIES
The Provider Enrollment Specialist is responsible for preparing and submitting applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. The specialist also processes new applications, revalidations, and updates rosters.
· Receive and analyze all verified documentation for Providers and execute provider enrollment with carriers.
· Process new enrollments, revalidations, updating rosters, and making sure all Providers are linked with their appropriate sites.
· Shares essential updates with Providers and internal teams as necessary in weekly summary reports or other correspondence.
· Collaborate with the Billing team on enrollment issues to investigate and correct.
· Work closely and effectively with the Insurance Carriers, Human Resources, and Providers.
· Correspond with Providers and Program Directors as necessary.
· Establish a relationship with the carrier credentialing representative and keep up on any changes or updates with the carriers.
· Maintain records in a safe and secure environment to remain in compliance with HIPAA.
· Communicate with Providers on any enrollment issues, needs, and updates.
· Update Providers CAQH accounts.
· Performs all other duties as assigned.
· 5 years of experience with onboarding providers in a medical or Human Resources environment required -OR- 5 years of complete provider enrollment processing/credentialing specific experience preferred.
· Detailed oriented and organized.
· Experience working with insurance carriers and the provider enrollment portals
· Excellent problem-solving and critical thinking skills.
· Able to perform with autonomy.
· Excellent communication skills across all levels in the agency.
· Familiarity with NCQA standards and how to apply them.
· Proficient with basic computer systems, networks, and software applications, such as the Microsoft Office Suite (Outlook, Word, and Excel).