Job Description
The Provider Enrollment Specialist facilitates the physician and mid-level enrollment applications process for Medicare, Medicaid, and commercial payers. This role is responsible for preparing and submitting supporting documentation for the purpose of enrolling individual physicians and mid-levels. This position is also responsible for follow up on the status of applications and tracking the progress on all pending applications.
Prepares Enrollment Documentation and Applications – 80%
- Initiates the payer enrollment process with all payers identified by client for enrollment
- Completes all required applications for submission to payers
- Coordinates credentialing data needed for enrollment, contracting, and other related purposes
- Creates providers in CAQH ProView as necessary
- Enters and updates clinician information in the database
- Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement
- Focuses on enrollment related continuous process improvement to ensure optimal operation
Internal and External Liaison - 20%
- Acts as liaison to CVO, clients, outside agencies, physicians, medical practice groups, health plans, etc.
- Responds to internal and external inquiries on routine enrollment and contract matters
- Works closely with clinicians to obtain missing documentation pertaining to provider enrollment
SECONDARY FUNCTIONS (IF APPLICABLE)
- May work on special projects or other duties as assigned
SUPERVISORY/BUDGETARY/EXTERNAL COMMUNICATION RESPONSIBILITY
- May communicate with clinicians, clients, and insurance providers
QUALIFICATIONS – EDUCATION, WORK EXPERIENCE, CERTIFICATIONS
- High School Diploma or equivalent required. Bachelor’s Degree preferred.
- 3+ years of related experience required
KNOWLEDGE, SKILLS, AND ABILITIES
- Ability to adhere to and exhibit the Company Values at all times
- Working knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Teams
- Working knowledge of CMS, PECOS, CAQH, NPPES payer credentialing software
- Working knowledge of PDF editing software
- Working knowledge of Salesforce
- Ability to build relationships at all levels - internally and externally
- Strong customer service mindset
- Strong organizational and time management skills
- Ability to work independently
- Strong communication skills - both oral and written
- Ability to work with sensitive information and maintain confidentiality
- Solid critical thinking and problem-solving skills
- Strong attention to detail and accuracy
KEY COMPETENCIES REQUIRED
- Business Insight
- Interpersonal Savvy
- Customer Focus
- Communicates Effectively
- Balances Stakeholders
- Organizational Savvy
- Action Oriented
- Instills Trust
- Resourcefulness
- Situational Adaptability
- Collaborates
PHYSICAL, MENTAL, WORKING CONDITION, AND TRAVEL REQUIREMENTS
- Typical office environment - sedentary with typing, writing, reading requirements
- May be able to sit or stand
- Speaking, reading, writing, ability to use a telephone and computer
- Ability to exert up to 10 lbs. of force occasionally
- Ability to interpret various instructions
- Ability to deal with a variety of variables under only limited standardization