Provider Enrollment Specialist - CAP
$52,000,000–$68,640,000 year
HybridIthaca, New York, United States
Job Summary
Manage the completion and submission of provider enrollment applications for Cayuga Health Partners providers according to plan specifications. Review and assess enrollment documents for completeness, including current state licensure and liability insurance, then follow up with physicians on missing information. Generate, mail, track, and process provider revalidation applications while maintaining a current and accurate Provider Roster. Act as a liaison between the Network, providers, and health plans to resolve approval delays and clarify requirements. Update the Provider Data Management System with new information and notify health plans of contract terminations or membership re-assignments. This role supports the Cayuga Health Partners Network and Centralus Health mission by ensuring continued Network compliance with NCQA, CMS, and NYS Department of Health regulations.
Required Qualifications
- Associate's degree
- Two to five (2-5) years of experience, including previous provider enrollment or credentialing experience with IPA / Medical Group / Hospital experience or healthcare operations experience (i.e. claims processing, billing, provider relations or contracting)
Desired Qualifications
- Notary Public certification preferred
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