Provider Enrollment Specialist

Provider Enrollment/Credentialing Specialist

Aviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families. Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.

Benefits Include:

• Monday - Friday Scheduling
• Paid Holidays
• PTO
• Comprehensive Medical, Dental, and Vision Coverage
• 403(b) Retirement with Employer Match
• Training and professional development opportunities
• Work-life balance as a Blue Zones participant

Position Purpose:

The Provider Enrollment/Credentialing Specialist is responsible for initiating and monitoring provider enrollment through the credentialing and recredentialing that is required for payer contracts. This position maintains logs of provider enrollment approvals, maintains a contact list for all payer contracts, and investigates any issues pertaining to provider enrollment with payers.

Essential Functions:

• Accurately and efficiently enrolls organization's healthcare providers with contracted insurance plans on behalf of the organization.
• Maintains provider enrollment spreadsheet by tracking provider approvals and statuses for DMAP, Medicare and all insurance payers.
• Provides consistent and timely follow-up to insurance payers to maintain provider's status in respective plans.
• Responds to all payer requests for additional/missing information through communication with providers.
• Ensures all providers appear in payer directories with correct information, taxonomies and specialties.
• Performs primary source verifications according to organizational and accreditation guidelines.
• Troubleshoots providers' application status with all insurance payers.
• Processes credentialing applications in accordance with federal, state and regulatory guidelines.
• Collaborates with Credentialing Specialist to ensure all information is documented in providers' files.
• Other duties as assigned.

Qualifications:

• High school diploma or GED required.
• Minimum of two years of provider enrollment and credentialing experience required.
• Ability to multitask, work independently, be organized and self-motivated.
• Proficiency with the use of computers, the internet and Microsoft or other similar products.

Aviva Health is an Equal Opportunity Employer We are committed to fostering a diverse and inclusive workplace where all qualified applicants receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.

Aviva Health is a Drug-Free Workplace

To ensure a safe and secure environment for our employees and patients, Aviva Health maintains a drug-free workplace. All employment offers are contingent upon passing a drug screening and a criminal background check. Compliance with these policies is required throughout employment.