Provider Enrollment Specialist

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

📋 Description

• The Provider Enrollment Specialist collaborates with the Provider Enrollment Manager to pinpoint issues or denials related to Provider Payer Enrollment.

• This role involves researching, addressing, and enrolling any payer-related issues by utilizing a range of proprietary and external resources.

• Responsibilities include reaching out to clients, operational staff, and the Centers for Medicare & Medicaid Services (CMS) through phone, email, or online platforms.

• Conducts follow-ups with market locations to investigate and resolve payer enrollment challenges.

• Engages with the Centers for Medicare & Medicaid Services (CMS) and other payers via phone, email, or website to rectify any Payer Enrollment concerns.

• Oversees the completion and submission of CMS Medicare, State Medicaid, and any additional third-party payer applications.

• Tracks and follows up to ensure that provider numbers are established and associated with the correct client group entity and appropriate software systems.

• Maintains accurate documentation and reporting regarding ongoing payer enrollments. Keeps records of finalized CMS applications.

• Develops strong working relationships with Clients, Operations, and the Revenue Cycle Management team.

• Proactively collects, monitors, and manages all payer revalidation dates for assigned groups/providers, as well as completes, submits, and tracks necessary applications to ensure active enrollment and prevent deactivation.

• Updates provider demographics in all relevant enrollment systems.

• Adds providers to all relevant systems and maintains information to ensure claims are held or released based on enrollment status.

• Undertakes special projects and other duties as required.

⛳️ Requirements

• Associate's degree (2 years) is required; Bachelor's degree in a related field is preferred.

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

• Familiarity with specific application requirements for the Centers for Medicare & Medicaid Services (CMS), State Medicaid, and all third-party payers, including prerequisites, required forms, completion criteria, and supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.

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

• Excellent oral, written, and interpersonal communication skills.

• Proficient in word processing, spreadsheets, databases, and presentation software.

• Strong attention to detail.

• Excellent analytical abilities.

• Effective decision-making skills.

• Strong problem-solving capabilities.

• Well-organized with strong time management skills.

• Ability to ensure that complex enrollment packages are complete and accurate.

• Capacity to work effectively in a team-oriented setting.

• Ability to cultivate positive working relationships both within and outside the organization.

• Self-motivated and capable of working independently with minimal supervision to achieve tasks.

• Commitment to maintaining strict confidentiality regarding protected provider and health information.

• Proactive approach to troubleshooting while concentrating on innovative solutions.

• Ability to exercise sound judgment and manage highly sensitive and confidential information appropriately.

• Adaptability to function in a collaborative and fast-paced environment.

• Skillful in communicating with diverse personalities in a tactful, mature, and professional manner.

🏝️ Benefits

• Eligibility for our Ventra performance-based incentive plan.

• Referral Bonus.