Provider Enrollment Specialist

This is a fully remote position, open to applicants in Kansas, +3 more states.

📋 Description

• Manage the entire provider enrollment lifecycle, which includes initiating contracts, reassessing benefits, and maintaining billing privileges.

• Oversee group practice location details in the enrollment database, such as clinic hours, NPIs, contract numbers, and contact details.

• Act as a technical resource for health plan reviewers during delegation oversight reviews.

• Generate intricate ad-hoc reports and rosters for health plan data inquiries and delegation reporting.

• Liaise with health plan and delegation oversight representatives concerning NCQA standards and their implementation.

• Utilize government and state-specific healthcare enrollment platforms to keep provider records and billing eligibility current.

• Collaborate with the Revenue Cycle team to address enrollment challenges and ensure accurate reimbursement.

• Coordinate the maintenance of National Provider Identifiers in national registries.

• Examine practitioner sanctions and adverse disclosures to ensure accurate and discreet communication with health plans.

• Handle revalidations and contract renewals while identifying any eligibility gaps.

• Monitor health plan effective dates and provide timely enrollment updates.

• Address complex claim holds and denials that arise from credentialing or enrollment issues.

• Perform additional duties as assigned.

⛳️ Requirements

• A High School diploma or G.E.D. is required.

• A minimum of 3 years of experience in provider enrollment, health plan administration, or medical staff services is required.

• Certification as a Provider Enrollment Specialist (CPES) or Provider Credentialing Specialist (CPCS) by NAMSS is required, or must be obtained within 12 months of hire.

• Extensive knowledge of NCQA accreditation standards and regulations regarding provider enrollment.

• Proficiency in communicating with health plan auditors and executive leadership.

• Expertise in healthcare database functionality, including complex rosters and custom data extracts.

• Advanced understanding of government enrollment portals and national provider registries.

• Ability to manage complex group practice data across various locations and Tax IDs.

• Skilled in identifying process bottlenecks and implementing collaborative solutions.

• Proficient in analyzing health plan contracts and enrollment requirements.

• Candidates must reside and work full-time in Arkansas, Kansas, Missouri, Oklahoma, or Texas before their first day of employment.

🏝️ Benefits

• Competitive wages and a comprehensive total rewards package.

• Paid Time Off (PTO).

• 401(k) plan.

• Medical insurance plans.

• Dental insurance plans.

• A thorough benefits and compensation package.

• Opportunities for both clinical and non-clinical career advancement.

• Reasonable accommodations for qualified individuals with disabilities.