Provider Enrollment Specialist

Full Time
Posted Today
Job description

Job Summary:

  • The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This may require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website.

Essential Functions and Tasks:

  • Performs follow-up with market locations to research and resolve payer enrollment issues
  • Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues
  • Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications
  • Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems
  • Maintains documentation and reporting regarding payer enrollments in process.
  • Retains records related to completed CMS applications
  • Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team
  • Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation
  • Maintains provider demographics in all applicable enrollment systems
  • Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment
  • Performs special projects and other duties as assigned

Education and Experience Requirements:

  • High School diploma or equivalent
  • Bachelor’s Degree in Healthcare Administration, Business Administration, Benefits, or equivalent training and/or experience preferred
  • At least one (1) year of provider enrollment experience preferred

Knowledge, Skills, and Abilities (KSAs):

  • Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.
  • Working knowledge of physician HIPAA Privacy & Security policies and procedures
  • Strong oral, written, and interpersonal communication skills
  • Strong word processing, spreadsheet, database, and presentation software skills
  • Strong detail orientation skills
  • Strong analytical skills
  • Strong decision-making skills
  • Strong problem-solving skills
  • Strong organizational skills
  • Strong time management skills
  • Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; and working with decimals
  • Ability to ensure the complex enrollment packages are complete and correct
  • Ability to work cohesively in a team-oriented environment
  • Ability to foster good working relationships with others both within and outside the organization
  • Ability to work independently and require little supervision, to focus on and accomplish tasks
  • Ability to maintain strict confidentiality with regards to protected provider and health information
  • Ability to take initiative and effectively troubleshoot while focusing on innovative solutions
  • Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
  • Ability to remain flexible and work within a collaborative and fast paced environment
  • Ability to communicate with diverse personalities in a tactful, mature, and professional manner
“This job can be performed remotely anywhere in the United States with the exception of California, Colorado, or New York.”

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