Provider Enrollment Specialist

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

📋 Description

• Collaborate with the Provider Enrollment Manager to pinpoint issues or denials related to provider payer enrollment.

• Investigate, resolve, and enroll in payer issues utilizing both proprietary and external tools.

• Engage with clients, operations staff, CMS, and other payers via phone, email, or websites.

• Analyze and address payer enrollment issues with market locations and payers.

• Complete and submit applications for CMS Medicare, State Medicaid, and various third-party payers.

• Monitor and follow up to secure provider numbers and associate them with the appropriate client group entities and software systems.

• Maintain accurate documentation, reporting, and records for payer enrollments and finalized CMS applications.

• Cultivate professional relationships with clients, Operations, and Revenue Cycle Management teams.

• Track payer revalidation deadlines and submit the necessary applications to uphold active enrollment and avoid deactivation.

• Keep provider demographics and enrollment statuses updated in relevant systems.

• Add providers to systems and ensure information is managed so that claims are either held or released based on their enrollment status.

• Execute special projects and other assigned responsibilities.

⛳️ Requirements

• Associate's degree (2 years) is required.

• Bachelor's degree in a related field is preferred.

• A minimum of one (1) year of experience in provider enrollment is preferred.

• Familiarity with CMS, State Medicaid, and third-party payer application requirements, prerequisites, forms, supporting documentation, and regulations is essential.

• Knowledge of physician HIPAA Privacy & Security policies and procedures is necessary.

• Excellent oral, written, and interpersonal communication skills are required.

• Proficient in word processing, spreadsheet, database, and presentation software.

• Strong attention to detail, analytical, decision-making, problem-solving, organizational, and time management skills are essential.

• Capability to complete and verify complex enrollment packages is necessary.

• Ability to work both independently and collaboratively in a fast-paced environment is required.

• Must maintain strict confidentiality regarding protected provider and health information.

• Ability to troubleshoot, show initiative, apply sound judgment, and manage sensitive information appropriately is important.

• Must possess the ability to communicate professionally with diverse personalities.

🏝️ Benefits

• Full-time day shift.

• Eligibility for Ventra's performance-based incentive plan.

• Discretionary incentive bonus in line with company policies.

• Opportunity for a referral bonus.