Provider Enrollment Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Support the organization in payer contracting initiatives, which encompass provider applications, contract evaluation, negotiations, and the credentialing of medical facilities and clinical providers.

• Ensure the contracting and credentialing department collaborates effectively with Sales/Marketing, Finance, Legal, Compliance, Medical, and Operations teams.

• Confirm that all medical and clinical personnel are properly credentialed with all payers and meet payer requirements.

• Assist the credential manager in recognizing new hiring requirements and aligning credentials with payer specifications.

• Review and prepare payer credentialing and recredentialing applications to ensure they are complete and accurate.

• Collaborate with providers and the credentialing department to gather necessary information.

• Work alongside Business Development, Marketing, and Finance to seek out opportunities for managed-care contract expansion.

• Assess and analyze contract proposals and partner with the SVP to negotiate contract rates.

• Act as a direct liaison between payers and ARS facilities concerning contracts, addendums, and credentialing requirements.

• Perform quality-control audits of files and implement measures to rectify and prevent future discrepancies.

• Generate reports for both internal and external stakeholders.

• Coordinate with the billing department to manage issues related to non-participating or disenrolled providers.

⛳️ Requirements

• A minimum of a High School Diploma or Equivalent is required.

• At least three (3) years of experience in provider or payer contracting and credentialing.

• Familiarity with Hospital and/or Behavioral Contracting and Reimbursement.

• Understanding of CAQH requirements and profiles.

• Experience in handling credentialing and re-credentialing applications for facilities and payer contracts.

• Proficient computer skills are essential.

• Must utilize a personal computer that meets the company's software and virus security standards.

• Windows 11 with the latest updates installed is required; Chromebooks and Apple computers are incompatible.

• Current antivirus software must be in place.

• A working camera and microphone are necessary.

• Candidates must reside in the US, specifically within the Eastern or Central Time Zone.

🏝️ Benefits

• Health, Vision, Dental, and Employer Matched 401(k).

• Short-Term Disability (STD), Long-Term Disability (LTD), and Employer Paid Term Life Policy – up to $50k.

• Employer Matched HSA – company contributions up to $1500 annually.

• Employee Wellness Program – reduces employee premiums by $40/month.

• Complimentary MDLive telehealth benefit.

• Paid Time Off including Vacation, Personal, Holiday, and Sick leave.

• Employee Referral Bonus.

• ARS offers reimbursement for remote office equipment.

• 401(k) plan available.

• Paid time off plan.

• Medical, dental, and vision coverage.