Provider Enrollment Specialist

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

📋 Description

• Gather, verify, and submit enrollment information for hospitals and physicians with Out-of-State Medicaid payers.

• Create and uphold state-specific policies and procedures for the enrollment of new hospitals and physicians.

• Stay informed about the enrollment requirements and regulations for hospital and physician Out-of-State Medicaid.

• Provide education and updates to internal team members, including the Vice President and Senior Vice President of Operations.

• Timely submit re-enrollment applications to ensure hospitals and physicians remain up to date.

• Examine Out-of-State Medicaid requirements for precision and adherence to governmental rules and regulations.

• Oversee work queues and deadlines for payer-specific forms and documents, such as license updates, deficiency notifications, and approval letters.

• Maintain provider files while documenting any changes, corrections, and terminations in the database.

• Manage patient health information while ensuring privacy and security of confidential and proprietary data.

⛳️ Requirements

• A High School Diploma or GED is required.

• An Associate's or Bachelor's Degree is preferred.

• At least 1 year of experience in the healthcare sector, specifically in billing or collections.

• A minimum of 1 year of client-facing or customer service experience.

• Intermediate understanding of insurance payer/provider claims processing and associated data requirements.

• Comprehensive knowledge of enrollment requirements and necessary documents for accurate application submission.

• Familiarity with general credentials and licenses is preferred but not mandatory, including hospital license, CLIA, DEA, NPI, and board certifications.

• Equivalent combinations of education and experience will be considered.

• Strong proficiency in computer usage and basic office applications, including MS Office (Word, Excel, and Outlook).

• Consistent and predictable attendance is essential.

• Ability to satisfactorily perform all essential duties.

• Capacity to meet and/or exceed productivity goals and targets.

• Ability to maintain stable performance under pressure or challenging situations.

• Ability to work autonomously without direct supervision.

• Excellent written and verbal communication skills are required.

• Strong analytical and problem-solving abilities.

• Proven experience working with external clients, along with strong customer service skills and business acumen.

• Ability to prioritize and manage multiple competing tasks and projects simultaneously.

• Must be able to remain in a stationary position for 50% of the time.

• Ability to operate a computer and office equipment effectively.

🏝️ Benefits

• Full-time employment.

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• Flexible work environment.

• Support for work-life balance.

• A family-oriented culture.

• Emphasis on employee collaboration and shared goals.