Provider Enrollment Specialist

Provider Enrollment Specialist Job Description Template

Our company is looking for a Provider Enrollment Specialist to join our team.

Responsibilities:

  • F Update the system and the credentialing database to reflect approvals, denials, and/or terminations;
  • Outreach providers as a result of mail being returned undelivered to XYZ COMPANY;
  • Assists call center agents, all internal departments, providers, and potential providers with resolving Provider Enrollment issues and inquiries;
  • Meets quality controls and production standards of the Provider Relations Department;
  • Enter and maintain all provider information into database;
  • Perform ongoing research to correct data so that it does not create duplicate providers, locations, and participation statuses;
  • Continuously searches for process improvements to achieve accuracy and efficiencies. (5%);
  • Verify prospective and current providers’ license, NPI, and other required enrollment documentation;
  • Performs other duties as assigned or required;
  • Assist with other duties as assigned;
  • Track contract applications status;
  • Maintain provider information by reviewing, entering, and following up on missing information;
  • Verify accurate banking and billing information;
  • Ensure all files have a welcome, denial, or term letter as appropriate;
  • Enter and maintain provider applications, revalidations, and updates into the system.

Requirements:

  • Good organizational skills;
  • Meet established production and quality goals/metrics;
  • Communicate and work well in a team environment;
  • Ability to learn new software programs quickly;
  • Proficient in the use of Excel;
  • Good basic math skills;
  • Excellent customer service skills;
  • Ability to adapt to constantly changing environment;
  • Excellent written and verbal communication skills;
  • Experience with general computer software (Word, Outlook required);
  • Strong business acumen;
  • Previous experience working with files or the collection and coordination of data (preferred);
  • Ability to make independent decisions;
  • Strong attention to detail;
  • Ability to prioritize and organize multiple tasks.