JOB DESCRIPTION OVERVIEW:
The Provider Enrollment Specialist is responsible for coordinating all necessary provider enrollment applications for billing to various carriers. This position is responsible for ensuring all applicable documents have been sent/received in a timely manner to the authorized signer and preparing/submitting a completed payer application. Responsibilities also include completing all CAQH’s and CAQH re-attestations, online applications and re-enrollment applications.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
◊ Generate "Applications Stopped in House" reports from Teamworks
◊ Review weekly exception reports from management to prioritize critical issues
◊ Preparing and sending applications to payers
◊ Completing online applications/CAQH
◊ Documenting data in Teamworks
◊ Requesting IDX# from billing center/IDX maintenance
◊ Resolving application deficiencies
◊ Update management when payers request additional forms or updating PE forms
◊ Train staff on provider enrollment processes
◊ Partner with Clinician Onboarding Liaison (COL) and Credentials Coordinator (CDR)
◊ Support Provider Enrollment department
QUALIFICATIONS / EXPERIENCE:
◊ HS Diploma or equivalent; Some college preferred
◊ One year of experience with contracts, legal documents or other health care related work
◊ Proficient in Microsoft Office applications
◊ Meticulous accuracy
◊ Ability to make decisions and solve problems
◊ Excellent communication skills (verbal and written); Ability to communicate effectively with Providers, Medical Directors and VPOs
◊ Excellent organizational skills with the ability to prioritize and manage multiple projects
◊ Ability to meet challenging deadlines; ability to function in stressful situations
◊ Ability to work in a team environment
◊ Overtime may be required; Some training and seminar attendance may require overnight travel.
