Title: Provider Enrollment Specialist III
Salary: Paid Per Client
Reports To: Team Lead & Operations Director
- Works in all phases of provider enrollment, re-enrollment, contracting, fee schedule review and negotiations, and expirables management ensuring the timely and accurate enrollment (and recredentialing) of providers into various payers (Medicare, Medicaid and commercial health insurance companies).
- Contacting payer(s) by phone, requesting network participation and follow up on submitted applications.
- Coordinate’s credentialing data needed for enrollment, contracting, and other related purposes.
- Completion & Submission of provider enrollment applications.
- Works closely with providers to obtain missing documentation.
- Obtains required client signatures and follows up with the carriers on documentation submitted on a weekly basis and per company policies.
- Processes all initial enrollment and re-enrollment applications, including revalidations for Medicare and/or Medicaid as requested.
- Follow-up and Follow-through on all submitted applications.
- Expirables management.
- CAQH set-up and CAQH re-attestations.
- Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
- Provide company feedback to reduce errors and improve processes.
- Anticipate customer needs and proactively identify solutions.
- Works independently and as a team solve complex problems.
- Provide utmost customer service.
- Adapt well in a changing environment.
- Act as the point of contact and supervisor in the absence of Team Lead.
- Performs data base and computer functions as required and per company policies – Extensive computer and software experience is a must – it is essential that you are very computer savvy since all work is done remotely.
- Performs other duties as assigned by their Team Lead.
- Minimum of 5 years of experience in provider enrollment/credentialing within a healthcare facility, physician group or managed care environment.
- Experience with PECOS, NCQA Standards, CMS regulations related to credentialing and conducting web-based research as required.
- The position requires excellent communication and organizational skills, the ability to prioritize tasks and projects and the capacity to know when to act independently but also when to ask for guidance or assistance.
- This is a position that is vital to the success of our company and clients and therefore, demands a customer service focused, organized and a passion for details individual.
- This position also requires a reliable and honest professional who has the ability to multi-task and develop positive working relationships with our clients.
- All of our coordinators work from their own home office, and therefore, must have a professional office set up to include a reliable PC (Desktop, not laptop or iPad), internet connectivity, scanner/printer and phone service.
- You must have the ability to work Monday-Friday, between normal business hours of 8am-5pm or 9am-6pm given the nature of our business.
- CPCS or CPMSM Certification a plus, but not required.
- Ideal candidate must be highly self-motivated with proven expertise in the healthcare physician credentialing, expirables management, re-credentialing and the provider enrollment environment.
- Ability to perform multiple assignments, good organizational, and time management skills.
- Strong clerical and computer skills.
- Strong organizational and follow up skills.
- Proficiency in Microsoft Office. Knowledge of credentialing software is helpful, but not required.
- Ability to interact effectively with a variety of people (physicians, mid-levels, medical staff offices, ancillary staff, and insurance reps).
- Provides the highest level of customer service to our customers.
- Strong written and verbal communication skills.
- Strong presentation and client interaction skills.
- College degree desired but not required.