Provider Enrollment Specialist

Description

The Provider Enrollment Specialist is responsible for requesting contracts and participation for providers in and with health plans to minimize the possibility of delay or non-payment of claims for services rendered by practitioners.


ESSENTIAL FUNCTIONS:

To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation:

Complete accurately CAQH credentialing process on new providers or groups.

Follow-up with payers for effective dates, and status updates on a regular basis.


Responsible for completing applications, re-credentialing applications, demographic updates, and documents to each payer for processing.

Research payers for information on processes to enroll providers/groups, contact representative information, and status of provider/group already in the system or not.


Candidate must be able to request a payor contract on behalf of a client.

Update and maintain CAQH database with all current provider information that is received from the client as well as updated licenses, DEA and add locations to the provider/group.

Monitor CAQH for expiring documents (i.e., license, DEA) and proactively contact client for updated information when required.


Monitor and maintain provider files to determine reason for pending enrollment and/or acknowledge all documents are received; request any documents and usernames/passwords needed for enrollments; routinely update status changes.

Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner.

Research payer enrollment questions and issues raised by clients and respond with resolution.

Complete and follow-up on Hospital re-appointment applications as requested by practice.

REQUIREMENTS:

Candidate must have 5 years of payor contracting/ payor enrollment experience in a fast-paced independent environment handling multiple tasks for multiple clients.


Candidate must be proficient in Microsoft Office products

Candidate must be able to work independently on projects and communicate project status to supervisor and client in a professional manner.


Experience with credentialing software a plus.