Provider Enrollment Specialist

Provider Enrollment Specialist

The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 47 states in three distinct categories: dental care, urgent care, and medical aesthetics. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Lovet Pet Health Care and Chapter Aesthetic Studio. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as a Provider Enrollment Specialist, which will be based remotely.

The Provider Enrollment Specialist plays a vital role within our Payor Strategy team. This position is responsible for managing and maintaining the enrollment and credentialing for Aspen Dental providers with insurance payers and assigned dental plans. This role ensures timely and accurate submission of provider applications, updates and recredentialing to facilitate uninterrupted billing, reimbursement and patient care. The successful candidate will report to the Enrollment Manager.

Key Responsibilities:

• Prepare, submit and track payer enrollment applications for new providers and existing provider changes.
• Maintain accurate records of all enrollment activities in the credentialing system.
• Communicate with insurance companies, healthcare providers and internal departments to ensure applications are processed efficiently.
• Monitor enrollment status and follow up with payers to resolve delays or issues.
• Update provider demographic and practice information with all contract payers as needed.
• Ensure recredentialing timelines and requirements are maintained so providers enrollment status remains intact with no lapses.
• Work closely with Field Support, Operations, Revenue Cycle Management (RCM) team to resolve any escalated enrollment or credentialing issues in a timely manner.
• Research and resolve out of network claims issues by investigating provider participation status and effective dates of enrollment.
• Coordinate temporary provider enrollments and ensure all necessary documentation, linkage and payer updates are completed.
• Collaborate closely with RCM on status of provider enrollments including providing reports submission as needed.
• Generate and maintain enrollment status reports.
• Support audits, and other duties as assigned.

Qualifications:

• High school diploma or equivalent required, associate or Bachelor's degree preferred.
• 1- 3 years of experience in payor enrollment.
• Working knowledge of commercial payors and government payor requirements.
• Proficient in Microsoft office and credentialing software including but not limited to CAQH, Availity.
• Strong attention to detail, organization and follow up skills.
• Excellent communication and customer service abilities interacting with internal teammates and external clients.
• Detail oriented, with strong level of analytical and problem-solving skills.

Preferred Skills:

• Experience in working with multi-specialty large group practices; dentistry is a plus.
• Knowledge of revenue cycle and billing processes.
• Familiarity with NPI and file provider management.

• Base Pay Range: $24.00-26.00 per hour (Actual pay may vary based on experience, performance, and qualifications.)
• A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match.