Provider Enrollment Specialist(Remote)

Provider Enrollment Specialist

California market experience is key. Examples: MediCal; Blue Cross Blue Shield of California. Must have experience with Department of Labor enrollments. Healthstream experience is preferred. Prior experience with internal auditing is key. CAQH experience is a plus.

Location: Fully remote role with expected work hours from 8:30 AM to 5PM CT Mon-Fri.

Summary Description: The Provider Enrollment Specialist will be responsible for coordinating the requests for participation in health insurance network as a medical provider, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliance manner with all government and commercial payors. They will also review provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements.

Job Responsibilities:

• Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
• Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified. Maintains positive working relationships with providers.
• Plays an active role in explaining providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes.
• Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
• Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data.
• Proactively obtains updated provider credentialing data prior to expiration. Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions. Completes all additions, updates, and deletions. Supports new provider onboarding processes as related to enrollment.
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
• Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management.
• Continuously searches for process improvements to achieve accuracy and efficiencies.
• Performs other duties as assigned or required.

Skills and Education:

• High School Diploma or equivalent.
• Experience in Radiology Payer Enrollment.
• 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements.
• Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools.
• Motivated to quickly learn and demonstrate strong problem-solving skills.
• Strong project management and multitasking skills.
• Excellent interpersonal and communication skills.
• Strong writing skills and attention to detail.
• Strong organizational skills and ability to be attentive to details.
• Demonstrated knowledge of healthcare contracts preferred

Company Benefits and Perks:

Joining comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.

• Access to a 401(k) Retirement Savings Plan.
• Comprehensive Medical, Dental, and Vision Coverage.
• Paid Time Off.
• Paid Holidays.
• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.