Provider Enrollment Specialist

SCP Health Opportunity

At SCP Health, what you do matters. As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

• Strong track record of providing excellent work/life balance.
• Comprehensive benefits package and competitive compensation.
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

Primary Duties and Responsibilities:

• Process and maintain provider applications for enrollment and re-enrollment for Medicare, Medicaid, BCBS and/or Commercial payors in accordance with Federal and State guidelines.
• Prioritize and manage multiple enrollments in a deadline-driven environment.
• Distribute, log, receive and scan Provider Enrollment Packets as assigned.
• Update National Provider Database information as needed.
• Monitor credentials, i.e. Medical License, DEA to ensure they are active and in good standing.
• Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.
• Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.
• Identify any issues with providers eligibility to participate in Government plans.
• Advise Supervisor/Manager immediately of any eligibility issues for providers.
• Procure all documents needed from Provider to enroll timely. Escalate to MSL on non-response providers.
• Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.
• Perform follow up on submissions via online, email or phone according to policies and procedures to ensure timely approval is received.
• Monitor Provider Enrollment AR on Hold reports for any held enrollment that should not be holding and identify and research any providers with held AR of 120 days to ensure no issues exist.
• Report any AROH related issues to Manager upon identification and correction.
• Assist with roster maintenance/training with global partners when needed.
• Update database with new implementation changes when directed by Management.
• Apply critical and strategic thinking in solving any enrollment related issues/concerns.
• Maintain accurate database information and perform data quality cleanup activities as directed by Management.
• Maintain confidentiality of privileged information.
• Work in CAQH database and maintain/update providers' credentials every 90 days.
• On occasion, may be required to be onsite at client facility to distribute PEPs and help facilitate in person enrollment.
• Once approval is received from payors, document approval and effective dates in Provider Enrollment system to ensure approvals and information are pushed to Billing System for release of claims.
• Monitor changes to payor requirements through payor websites, bulletins, emails, etc and communicate any changes to appropriate Managers to ensure changes are made wherever applicable.

Required Skills and Qualifications:

• Work independently utilizing documented processes and automated daily reports generated from database.
• Must work independently with little or no oversight.
• When payor requirements change, must be able to analyze and compare processes in order to recommend process solutions to Management.
• Agility in managing multiple priorities with strong organizational and time management skills.
• Knowledge of Payor Credentialing processes, both Par and Non-Par.
• Knowledge of Provider Credentials.
• Experience working in CAQH database and National Provider Identifier database
• Knowledge of CMS Regulations and guidelines.
• Proficient in Microsoft Office applications including Word and Excel.
• Ability to foster a cooperative and respectful work environment.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Ability to communicate effectively both orally and in writing.
• Minimum 3 years of Provider Enrollment/Payor Credentialing experience required.

Preferred Skills and Qualifications:

• Experience with Availity and other provider related credentialing/enrollment databases.
• Experience working with Medicare, Medicaid or any Commercial payor.
• Experience working with Credentialing/Enrollment software.

Education:

• HS Diploma required.
• B.A. in Healthcare or Business Administration or equivalent experience preferred.

Certificates and Licenses: (Preferred)

• PESC (Provider Enrollment Specialist Certification)
• CPCS (Certified Provider Credentialing Specialist)

Primary Location:

• Remote - United States

Pay Range:

15.00 - 21.00 USD per hour

This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.

We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.