Provider Enrollment Specialist

Public Trust: None

Requisition Type: Pipeline

Your Impact

Own your opportunity to support the missions that matter. From working with technologies like AI, cyber and cloud to careers in intelligence and health, we offer endless opportunities to apply your expertise to create a safer, smarter world while building new skills to propel your career forward.

Job Description

As a Provider Enrollment Specialist, you will be responsible for coordinating and managing the enrollment and credentialing process for healthcare providers. Your primary goal is to ensure that providers are properly credentialed, contracted, and able to deliver services to patients. You will collaborate closely with internal departments, external agencies, and providers to facilitate timely and accurate enrollment.

A day in the life of a Provider Enrollment Specialist:

• Application Processing: Review and process enrollment applications accurately and efficiently, ensuring all information is complete and meets regulatory requirements.

• Credentialing: Ensure providers meet credentialing requirements by verifying education, training, licensure, certifications, and other qualifications.

• Provider Relations: Serve as a primary point of contact for the Provider Relations team regarding enrollment status, application requirements, and related inquiries.

• Compliance Monitoring: Monitor and track provider enrollment status and deadlines to ensure compliance with regulatory and contractual obligations.

• Database Management: Maintain accurate provider information in databases and enrollment systems, ensuring data integrity and accessibility.

• Reporting: Generate reports on provider enrollment status, trends, and issues for management review and decision-making purposes.

Knowledge, Skills, and Abilities:

• Detail-oriented and analytical mindset

• Strong problem-solving and decision-making abilities.

• Ability to maintain confidentiality and handle sensitive information.

• Customer service-oriented with strong interpersonal skills.

• Adaptability to changing priorities and requirements.

To qualify for this role, YOU MUST have:

• 4 or more years of related experience (education may be substituted in lieu of experience)

• Demonstrated experience utilizing strong organizational skills with attention to detail and accuracy

• Demonstrated experience utilizing verbal and written communication skills to inform diverse audiences of an organization

• Demonstrated ability to prioritize workload effectively, manage multiple projects concurrently, and consistently meet established deadlines

• Intermediate proficiency in MS Office Suite

• Must be able to work any 8-hour shift, Monday through Friday, 8:00 a.m. to 7:30 p.m. CST

Even BETTER if you have :

• Knowledge of healthcare regulations, payer requirements, and managed care principles. -

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field

• Previous experience in provider enrollment, credentialing, or healthcare administration.

• Experience with enrollment software or databases (e.g., CAQH, NPPES)

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Work Requirements

Years of Experience

4 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

None