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Provider Enrollment Maintenance Representative in Raleigh, NC at TeamHealth

Date Posted: 10/31/2019

Job Snapshot

Job Description

Job Description Overview:

The Provider Enrollment Maintenance Representative is responsible for proactively completing all provider enrollment maintenance activities. This position is responsible for minimizing any lapses in clinician enrollment and write off’s/holds related to maintenance activities. This position is responsible for verifying maintenance requirements, ensuring centralized payer library is current and communicating updates to management and colleagues.


Essential Duties and Responsibilities:

  • Complete all maintenance activities including research, recording, communication & information sharing, submission, confirmation and follow up
  • Maintenance activities include, but are not limited to:
    • Medicare & Medicaid revalidations
    • Recredentialing for all payers
    • Creation and maintenance of CAQH practice and clinician profiles
    • Submission of clinician updates e.g. licensure and certificates of insurance to payers
    • Completion of any/all requests for data validation from payers and internal customers
    • Manage roster submission, review and data entry.
  • Collaborate with colleagues to resolve enrollment related denials associated with maintenance
  • Collaborate with analyst and/or HCFS to proactively monitor enrollment status for payers that require claim activity to remain participating
  • Partner with Lead to communicate any form updates requires in AppGen
  • Partner with Manager to communicate any payer maintenance activity updates required in the payer library
  • Occasional overtime and/or participation on special projects may be required
  • Other duties as assigned


Job Requirements


  • Ability to operate effectively in a fast paced environment
  • Demonstrate a systematic approach in carrying out assignments; methodical in planning and performing; effective prioritization required
  • Display a high standard of professional conduct
  • Perform with a high degree of accuracy; give meticulous attention to detail


    • Work harmoniously and effectively across all levels of the business; cooperate with others for the benefit of the organization
    • Communicate clearly, concisely, positively and professionally
  • Show genuine interest in continuous development in professional and technical skills
  • High school diploma or equivalent; some college preferred
  • One year of experience with health care or comparable industry


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