Provider Enrollment Specialist

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

📋 Description

• Annually prepare, submit, and scan around 1,000 provider enrollment applications for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH, and various other payer programs.

• Oversee payer portal access for individual providers.

• Submit applications for audit to supervisors/managers and aim for an error rate below 10%.

• Track applications to ensure approvals are obtained and communicated to the billing team prior to timely filing.

• Manage daily administrative responsibilities and improve workflow efficiency.

• Prioritize requests, handle workload, and implement project plans within established deadlines.

• Work remotely full-time and operate autonomously with minimal supervision.

• Address internal and external inquiries related to enrollment and contract issues, including bi-weekly payer follow-ups as necessary.

• Act as a liaison among the billing company, providers, and payer representatives to resolve enrollment challenges.

• Coordinate credentialing for initial, updating, add-on, and maintenance applications.

• Maintain strict confidentiality of provider credentials while communicating with providers and departments.

• Set up Salesforce record types, dashboards, reports, and custom settings.

• Update Salesforce with billing numbers, contract details, application dates, communications, and issues.

• Document ongoing and pending tasks in databases.

• Utilize Salesforce Data Loader for bulk data imports.

• Employ DocuSign to distribute provider enrollment documents, obtain signatures, and follow up with carriers.

• Deactivate inactive providers from Medicare, Medicaid, and other payers to ensure regulatory compliance.

• Maintain data integrity and engage in compliance training and development.

• Review pro forma for new contracts and assist in safeguarding revenue.

• Investigate and resolve payer issues in collaboration with payers and the billing company.

• Participate in payer training sessions and webinars to implement process enhancements.

• Assist in research, review, and testing of educational materials for organizational growth.

⛳️ Requirements

• High School Diploma coupled with relevant work experience is required.

• 2-4 years of related healthcare experience is required.

• A Bachelor’s degree is preferred.

• Over 3 years of relevant healthcare experience is preferred.

• Familiarity with billing or reimbursement processes is desired.

• Experience in Provider Enrollment is desired.

• Proficiency in interacting effectively with providers, payer representatives, internal departments, team members, and other stakeholders through both written and verbal communication.

• Capability to complete tasks thoroughly and accurately.

• Strong time management and organizational skills.

• Willingness to learn about billing processes, including timely filing and reasons for claims denial.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, OneDrive, PowerPoint, etc.).

• Knowledge of additional technology-based tools (Teams, SharePoint, etc.).

• Understanding of online Medicare/Medicaid enrollment systems, Identity & Access systems, Counsel for Affordable Quality Healthcare systems, Medicare enrollment specialties, and National Provider Identifier taxonomies.

• Knowledge of Medicaid enrollment procedures, including revalidations, medical license expirations, deactivations, NPI taxonomy significance, Medicaid managed care data flows, Medicaid billing manuals, state administrative codes, border-state enrollment, and out-of-state enrollment.

• Familiarity with Salesforce, including Individual Enrollment Contracts, Group Enrollment Contracts, Contracts, Work History, Provider Status, and Clinical Activities objects, dashboards, and reporting.

• Development of critical thinking skills and professional relationships.

🏝️ Benefits

• Monthly wellness events and programs such as yoga, HIIT classes, and more.

• Trainings designed to support and advance your professional development.

• Team-building activities including virtual scavenger hunts and holiday celebrations.

• Flexible work hours.

• Opportunities to engage in Vituity community events like LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more.

• Comprehensive health plan options.

• Coverage for dental, vision, HSA/FSA, life and AD&D, and more.

• Top-tier 401(k) retirement savings plans offering a $1.20 match for every dollar up to 6%, plus discretionary profit-sharing contributions (eligible January following 18 months of service).

• Generous paid time off starting at 3-4 weeks annually.

• Discounts on student loan refinancing.

• Professional and Career Development Program.

• Inclusion of EAP and travel assistance.

• A wellness program.

• A purpose-driven culture focused on enhancing the lives of our patients, communities, and employees.

• An annual corporate Success Sharing bonus program based on the company's yearly performance.