Provider Enrollment Specialist

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

📋 Description

• Oversee the timely, efficient, and precise economic credentialing and provider enrollment for medical billing providers and facilities.

• Assist providers throughout the credentialing, enrollment, recredentialing, and revalidation processes for managed care, Medicare, Medicaid, NPPES, and I&A.

• Create, maintain, and oversee credentialing and enrollment databases along with relevant effective dates.

• Ensure that all contracted managed care payers, Medicare, Medicaid, and other governmental plans reflect an active status.

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

• Monitor registration packets and notify hiring managers or recruiters of potential issues.

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

• Collaborate with leaders to incorporate facilities, practice locations, providers, and services under existing contracts.

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

• Evaluate and troubleshoot credentialing and provider enrollment challenges that impact payment.

• Address issues, propose solutions, or escalate complex situations as needed.

• Work closely with the Director of Professional Services, Manager of Professional Services, and Supervisor of Managed Care on daily operations and special initiatives.

• Uphold confidentiality at all times.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• Minimum of two (2) years of experience in the healthcare industry.

• Fundamental understanding of messenger model networks and managed care contracting as they relate to the credentialing process.

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

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

• Exceptional attention to detail and accuracy.

• Capability to work independently with minimal supervision in a dynamic and fast-paced environment.

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

• Ability to build and maintain effective working relationships with providers, staff, and other agencies.

• A positive service-oriented attitude when interacting with internal and external customers.

🏝️ Benefits

• Full-time position.

• 40 scheduled hours per week.