Provider Enrollment Specialist

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

📋 Description

• Responsible for managing requests for participation in the health insurance network as a medical provider.

• Overseeing and ensuring the provider enrollment and re-enrollment processes are conducted in a timely and compliant manner.

• Assessing provider credentialing and/or recredentialing data for accuracy according to licensing and various insurer payer requirements.

• Completing provider payer enrollment/credentialing and recredentialing with all designated payers promptly.

• Addressing enrollment issues by collaborating with physicians, non-physicians, office staff, management, contracting, insurers, and others.

• Maintaining positive relationships with providers.

• Actively explaining the submission requirements for credentialing/recredentialing processes to providers and practice/office managers.

• Gathering updated provider information from multiple sources such as provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.

• Identifying and resolving issues with primary source verification elements through data interpretation, analysis, and research.

• Proactively obtaining updated provider credentialing data before expiration.

• Creating, developing, and managing relevant matrices and/or utilizing departmental software to support enrollment functions.

• Completing all additions, updates, and deletions as necessary.

• Assisting with new provider onboarding processes relating to enrollment.

• Communicating updated payer enrollment information, including payer provider numbers, to practice operations in a timely manner.

• Promoting collaboration and teamwork with departments, vendors, and other stakeholders.

• Developing databases and spreadsheets to track organization providers.

• Ensuring data is accessible and transparent for executive inquiries or other management-required information.

• Continuously seeking process improvements to enhance accuracy and efficiency.

• Performing other duties as assigned or required.

⛳️ Requirements

• Experience in the California market is essential.

• Must possess experience with Department of Labor enrollments.

• Healthstream experience is preferred.

• Prior experience with internal auditing is crucial.

• CAQH experience is a plus.

• High School Diploma or equivalent is required.

• A minimum of 5 years' experience in a physician medical practice with a foundational understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements.

• Proficiency in Microsoft Word, Excel, Outlook, PDF software, and other management tools.

• Self-motivated with a strong aptitude for problem-solving.

• Excellent project management and multitasking abilities.

• Outstanding interpersonal and communication skills.

• Strong writing abilities and attention to detail.

• Exceptional organizational skills with a focus on detail.

• Demonstrated knowledge of healthcare contracts is preferred.

🏝️ Benefits

• A wide range of benefits upon joining.

• Flexible work hours when feasible.

• A genuine sense of belonging within a dynamic and growing organization.

• Access to a 401(k) Retirement Savings Plan.

• Comprehensive Medical, Dental, and Vision Coverage.

• Paid Time Off.

• Paid Holidays.

• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.