SUMMARY OF DUTIES

The Senior 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. This role also processes new applications, revalidations, and updates rosters with external.

POSITION RESPONSIBILITIES

• Maintain updated knowledge of Provider Enrollment regulations and propose new/updates to existing procedure documentation.
• Provide training on procedures to appropriate HR team members, as requested.
• Collaborate with insurance carriers to ensure the team is enrolling new BestSelf programs by following the applicable requirements and enrollment procedures in a timely manner.
• Investigate new external electronic platforms used by insurance carriers and ensure the team is prepared to utilize efficiently and effectively.
• 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.
• Completes all trainings required by the agency.
• Performs all other duties as assigned.

QUALIFICATIONS

• 3+ years of complete provider enrollment processing/credentialing specific experience required.
• Experience working with insurance carriers and the provider enrollment portals.
• Excellent attention to detail, organization, and time management skills.
• Excellent problem-solving and critical thinking skills.
• Able to perform with autonomy.
• Excellent communication skills using all methods and with all levels in the agency.
• Proficient with the Microsoft Office Suite (Outlook, Word, and Excel).