Provider Enrollment Specialist

Role Overview

• Provides ongoing support and coordination as a liaison between the Medical Staff, Medical Directors, and Administration.
• Directs the ongoing credentialing / privileging process and other administrative functions for the Medical Staff, Medical Director, Administration, and Allied Health Professionals.
• Participates in enrollment progress update meetings for assigned market.
• Provides status information to stakeholders.
• Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators.
• Completes all payer re-credentialing requests and demographic/roster requests.
• Completes out-of-State Medicaid individual and facility enrollments timely and accurately for assigned States.
• Participates in team work sessions for each market to address Epic hold and denial work queues and communicate issues and trends to leadership.
• Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.

Requirements

• High School Diploma or Equivalent
• One year experience in a healthcare revenue cycle setting.
• One year of experience working with governments payers and/or commercial payers in a revenue service setting.
• Demonstrated knowledge of working medical billing database work queues.

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.