Provider Enrollment Specialist

Responsibilities:

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• Responsible for the timely completion of government enrollment applications for all medical and behavioral health providers and groups.
• Update and maintain all necessary government credentialing and revalidations for all providers.  
• Interact with providers via phone or email as needed
• Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within the specified systems and time frames.
• Build knowledge base for payor requirements and forms.
• Develop working knowledge of payor policies for multiple states.
• Ability to proficiently communicate and collaborate with the RMC team, Credentialing team and Billing Partners to resolve provider denials credentialing related claims issues.
• Participate in team huddles and ongoing process improvement.
• Works with the Manager of Provider Enrollment when changes are needed for the Procedure manual to ensure all payor enrollment processes are documented, accurate and effective.
• Responsible for all aspects of user online access (i.e.: PECOS/Web Portals, etc.)
• Attend conference calls with clients as requested
• Other duties as assigned

Requirements:

• 1-2 yrs Experience working directly with payors regarding credentialing, enrollment, and contracting
• Demonstrated experience following up with payors on the status of applications and telehealth
• Knowledge of CAQH, NPPES and PECOS systems