Provider Enrollment Specialist

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

📋 Description

• Prepare, submit, and monitor payer enrollment applications for both new providers and modifications for existing providers.

• Maintain precise records of enrollment activities within the credentialing system.

• Liaise with insurance companies, healthcare providers, and internal departments to ensure smooth processing.

• Track enrollment status and follow up with payers to address delays or issues.

• Update provider demographic and practice details with contracted payers.

• Adhere to recredentialing timelines and requirements to avert enrollment interruptions.

• Work in collaboration with Field Support, Operations, and Revenue Cycle Management teams on escalated enrollment or credentialing matters.

• Investigate and resolve out-of-network claims issues by checking provider participation status and enrollment effective dates.

• Coordinate temporary provider enrollments and complete necessary documentation, linkages, and payer updates.

• Collaborate with RCM regarding enrollment status and provide reports as required.

• Generate and maintain reports on enrollment status.

• Assist with audits and undertake other tasks as assigned.

• Report directly to the Enrollment Manager.

⛳️ Requirements

• A high school diploma or equivalent is required.

• An Associate or Bachelor’s degree is preferred.

• 1–3 years of experience in payer enrollment is necessary.

• Familiarity with commercial payors and government payer requirements is essential.

• Proficient in Microsoft Office and credentialing software, including CAQH and Availity.

• Strong attention to detail, organizational skills, and follow-up capabilities are crucial.

• Excellent communication and customer service skills for interacting with internal teammates and external clients.

• Strong analytical and problem-solving abilities are required.

• Experience with multi-specialty large group practices is preferred; dentistry experience is a plus.

• Knowledge of revenue cycle and billing processes is advantageous.

• Familiarity with NPI and provider management files is preferred.

🏝️ Benefits

• Paid time off

• Health insurance

• Dental insurance

• Vision insurance

• 401(k) savings plan with matching contributions