Provider Enrollment Specialist

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

📋 Description

• Accurately and promptly enroll practitioners in health plans.

• Track enrollment progress and ensure adherence to completion timelines.

• Provide enrollment updates to relevant RCM central business offices.

• Support management in achieving provider enrollment objectives across all divisions.

• Validate existing plan enrollment forms, complete applications, submit them to health plans, and follow up until enrollment is finalized.

• Confirm the accuracy and coordinate the entry of provider information into IntelliCred and the Master Database.

• Organize forms in IntelliCred, prioritize tasks, and investigate health plan enrollment requirements.

• Record assignments in the Credentialing/Provider Enrollment tracking system.

• Reach out to health plans to ascertain enrollment requirements and verify specialty-specific criteria.

• Prepare and review group applications for acquisitions, Tax ID mergers, and Organic Growth Initiatives.

• Collaborate with Business Development, Business Integration, and Credentialing to secure necessary documents and signatures.

• Maintain provider profiles in the Provider Enrollment tracking system and CAQH.

• Monitor delegated agreement health plan enrollment reports and aging reports.

• Validate onboarding enrollment status to align with Target Start Dates.

• Escalate enrollment issues to Provider Enrollment Management as required.

• Execute other job-related responsibilities as requested by Provider Enrollment Management.

⛳️ Requirements

• Associate's degree (A. A.) or equivalent from a two-year college or technical school.

• A minimum of three (3) years of related experience or an equivalent combination of education and experience.

• Familiarity with Group Entity health plan enrollments, state regulations, and appeal processes.

• Understanding of Provider Enrollment policies and procedures.

• Capability to read, analyze, and interpret both common and technical journals, financial reports, and legal documents.

• Ability to address inquiries or complaints from customers, regulatory agencies, or business community members.

• Proficiency in writing speeches and articles for publication that adhere to established style and format.

• Skill in presenting information to senior management, public groups, and/or boards of directors.

• Competence in working with probability, statistical inference, plane and solid geometry, and trigonometry.

• Ability to apply fractions, percentages, ratios, and proportions to real-world situations.

• Proficient in defining problems, gathering data, establishing facts, and drawing valid conclusions.

• Ability to interpret technical instructions in mathematical or diagrammatic form and manage abstract and concrete variables.

• Knowledge of medical terminology and protocols.

• Experience with Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue, CAQH, and IntelliCred.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Disability insurance.

• Healthcare FSA.

• Dependent Care FSA.

• HSAs.

• 401k plan.

• Employee Stock Purchase Program.

• Voluntary benefit plans.

• Payroll deductions for benefits.