Provider Enrollment Specialist

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

• Execute timely, efficient, and precise economic credentialing and provider enrollment for medical billing providers and facilities associated with contracted managed care and governmental plans.

• Assist providers through the processes of economic credentialing, enrollment, recredentialing, and revalidation, which includes managed care, Medicare, Medicaid, NPPES, and I&A.

• Create, maintain, and oversee the credentialing/enrollment database along with associated effective dates.

• Ensure active status among contracted managed care payers, Medicare, Medicaid, and various other governmental plans.

• Verify that licenses and certifications are accurate and current across all markets.

• Monitor the return of registration packets and notify hiring managers and recruiters of any issues.

• Generate and manage reports that track registration and communicate enrollment status to leadership and billing units.

• Coordinate information for new facilities, practice locations, providers, and services that fall under existing contracts.

• Act as an educational resource and consultant on the enrollment of facilities, practice locations, and various provider types.

• Analyze and address provider enrollment and credentialing issues that may impact provider payments.

• Resolve issues, propose solutions, or escalate complex matters as needed.

• Collaborate with the Director of Professional Services, Manager of Professional Services, and Supervisor of Managed Care on daily operations and special projects.

• Uphold confidentiality in all aspects of the role.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• A minimum of two (2) years of experience in the health care industry.

• Preferred experience in professional billing, physician’s office, or credentialing within the health care sector.

• Basic understanding of the messenger model network and managed care contracting as it pertains to the credentialing process.

• Fundamental knowledge of credentialing policies, regulatory requirements, and accreditation standards.

• Strong analytical, problem-solving, time management, planning, and organizational capabilities.

• Exceptional attention to detail and accuracy.

• Ability to work independently with minimal supervision in a demanding and fast-paced setting.

• Intermediate proficiency in Microsoft Word, Excel, Access, and Outlook.

• Ability to establish and nurture effective working relationships with providers, staff, and other agencies.

• Positive service mindset when interacting with internal and external customers.

🏝️ Benefits

• Full-time schedule of 40 hours per week.

• Standard office environment.