Provider Enrollment Specialist
$31,200–$43,680 year
RemoteUnited States
Job Summary
Process and maintain provider applications for enrollment and re-enrollment across Medicare, Medicaid, BCBS, and Commercial payors while adhering to Federal and State guidelines. Distribute, log, receive, and scan enrollment packets; update the National Provider Database and CAQH records with active credentials and license status. Serve as the primary contact for providers and payors regarding enrollment questions, escalate non-responses to MSL, and monitor hold reports to resolve AROH issues. Perform data entry, follow up on submissions via email or phone, and document approval effective dates to push information to the Billing System. Analyze payor requirement changes and communicate updates to managers. Work independently with minimal oversight, utilizing documented processes and automated reports to manage multiple priorities in a deadline-driven environment.
Required Qualifications
- Minimum 3 years of Provider Enrollment/Payor Credentialing experience
- HS Diploma
- B.A. in Healthcare or Business Administration or equivalent experience
- Knowledge of Payor Credentialing processes, both Par and Non-Par
- Knowledge of Provider Credentials
- Experience working in CAQH database and National Provider Identifier database
- Knowledge of CMS Regulations and guidelines
- Proficient in Microsoft Office applications including Word and Excel
- Ability to foster a cooperative and respectful work environment
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
- Ability to communicate effectively both orally and in writing
- Must work independently utilizing documented processes and automated daily reports generated from database
- Must work independently with little or no oversight
- Agility in managing multiple priorities with strong organizational and time management skills
- When payor requirements change, must be able to analyze and compare processes in order to recommend process solutions to Management
Desired Qualifications
- Experience with Availity and other provider related credentialing/enrollment databases
- Experience working with Medicare, Medicaid or any Commercial payor
- Experience working with Credentialing/Enrollment software
- PESC (Provider Enrollment Specialist Certification)
- CPCS (Certified Provider Credentialing Specialist)
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