The Senior Provider Enrollment Specialist is responsible for processing enrollments for new and existing providers. Other responsibilities include ensuring the enrollment process is accurate for all payers and states; problem solving enrollment issues and holds; escalating the need for provider appeals with payers for effective date issues and supporting the Provider Enrollment Specialist(s).
Primary Duties and Responsibilities:
- 20%: Ensure provider participation with contracted/non-contracted payors by taking appropriate actions to complete enrollment prior to the provider’s first shift or anticipated start date utilizing the department Standard Operating Procedures
- 15%: Work with payors and providers to ensure compliance with enrollment process to include updating department Standard Operating Procedures as needed to keep current
- 15%: Review active roster to ensure all providers have payor numbers and/or going through the enrollment process (i.e., work with billing partner to reconcile rosters between systems as needed)
- 15%: Meet with Representatives from Credentialing and Recruiting Departments so all potential and signed providers are going through the PE process to include, but not limited to, ensuring the weekly Pipeline reports are reviewed, notes made and that weekly calls are attended
- 10%: Meet and maintain established department metrics for production and quality and serving as a subject matter expert for provider enrollment along with providing department training for payer(s)
- 5%: Working additional reports as needed to ensure no loss of revenue
- 5%: Review incoming mail/correspondence received from payor and providers and perform appropriate action to resolve
- 5%: Appropriately resolve or escalate payor application denials, rejections, and appeals
- 5%: Maintain working knowledge of workflow, systems and tools used in the department
- 5%: Other duties as necessary to support the success of the Provider Enrollment Department
Knowledge and Experience:
- High School Diploma or GED required.
- Minimum three years related provider enrollment experience.
- Knowledge of Governmental and Commercial Payor processes and guidelines.
- Knowledge of NPPES and CAQH required.
- Demonstrate ability to meet and exceed expectations.
- Communicate clearly and concisely.
- Demonstrate proficiency in Microsoft Office application and other applications as required.
- Demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes.
- Ability to work quickly and accurately in a fast-paced environment while managing multiple demands.
- Ability to work both independently and collaboratively as a team player.
- Demonstrates adaptability, analytical and problem-solving skills with attention to detail.
- Ability to work effectively with other employees and external parties.
- Establish and maintain provider and payor relationships, building trust and respect.
- Requires prolonged sitting/standing.
- Requires manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
- Occasional lifting and carrying up to 20 pounds.
- Light travel may be required.
- High level of mental awareness
- High level of attention to detail
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Note: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
*INTERNAL CANDIDATES: To be considered for an open position, you must be in good standing (i.e., not on a Performance Improvement Plan) and in your current position for at least six months. You must also meet the minimum requirements for the job and be able to perform the essential functions of the position.