4550- Provider Services Specialist

About The Role

The Provider Services Specialist is responsible for the completion of enrollment tasks and the follow-up on credentialing-based holds and denials. The ideal candidate for the position follows the key performance goals as established by Caduceus for its client base of large-scale, multi-specialty healthcare organizations. The Provider Services Specialist is responsible for the escalation of new and existing : fielding, escalating, tracking, and trending payer, provider, or billing platform issues identified by his or her team and communicated to client and Caduceus management.

A Day in the Life

• Demonstrates a thorough knowledge and proficiency in all aspects of provider enrollment in a professional healthcare practice setting.
• Provides support on front end holds and back-end denials with a goal of follow up and resolution
• Reports on new and existing issues to upper administration
• Processes tasks from Enrollment Worklist including Credentialing Status, Payer Affiliation, Forms, and Online Enrollments.
• Assist with EDI, ERA, EFT, and Athena payor portal access
• Updates and maintains all Payer Enrollment groups and statuses as directed by lead or administration
• Possess a working knowledge and effective navigation of insurance portals including CAQH.
• Acts as liaison with Practitioners, billing management and insurance carriers.
• Performs other assigned duties/tasks
• Demonstrates mastery of the above essential functions with passing grades in testing environment.

Requirements

• Athena Experience required.
• Bachelor's degree preferred or equivalent experience in business/healthcare environment.
• 3+ years of applicable experience in credentialing and enrollment.
• Multi-specialty experience is a big plus.
• Experience working in a medical billing environment where compliance with protected health information and HIPAA compliance is strongly enforced
• Excellent written and verbal communication skills with superior attention to detail
• Ability to multi-task under tight timelines with strong administrative and exceptional organizational skills.
• Proficient in Microsoft Office Suite; Word, Excel, PowerPoint, and Outlook
• Advanced knowledge credentialing databases or reporting systems.

Benefits

• Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance
• Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry's most generous parental leave policies to support you during life's most important moments
• Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won't go unnoticed
• Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance