Provider Enrollment Specialist

About the role

This position manages the enrollment and re-enrollment application process for all AltaPointe Health System providers with applicable commercial, federal, and state payer plans.

Responsibilities

• Complete accurate enrollment applications for new providers in a timely manner.
• Maintain accurate information regarding re-enrollment standards for all payers.
• Submit re-enrollment applications promptly to ensure providers remain up to date with their re-enrollment status.
• Follow up with contractual insurance carriers regarding provider/facility enrollment, termination, or relocation status.
• Enroll all providers in CAQH and provide re-attestations as needed.
• Maintain the Credentialing Software Database.
• Issue monthly reports from the Credentialing Software Database to communicate provider enrollment status.
• Provide additional status reports and updates as needed.
• Update the provider enrollment matrix.
• Track progress of outstanding applications and inform appropriate parties of in-network effective dates.
• Proactively communicate with Human Resources regarding enrollment department needs and requirements related to provider information.
• Work closely with providers to obtain necessary documentation and assist in obtaining/updating an NPI number.
• Collaborate with the billing department to resolve provider-based denial issues related to enrollment.
• Communicate with billing staff regarding provider enrollment status with individual payers and report significant delays to management.
• Assist with maintaining Practitioner Enrollment forms in all Electronic Health Records in a timely manner.
• Demonstrate courteous and respectful behavior toward patients, visitors, and co-workers, treating patients with care, dignity, and compassion while respecting privacy and confidentiality.
• Actively participate in Performance Improvement activities and AHS committees as requested.
• Complete assigned tasks in a timely manner and follow AHS policies and procedures.
• Respond to billing inquiries promptly and courteously.
• Assist with duties of other staff during periods of absence.
• Perform other duties as assigned by supervisor.

Requirements

• Associate’s degree in business or a related field. Three to five years of related work experience may be substituted for the education requirement.
• A minimum of three years of prior experience in provider enrollment, credentialing, or billing is required.
• Demonstrated problem-solving skills and ability to work in a fast-paced environment with a flexible attitude.
• Working knowledge of MS Office (Excel, Word, etc.).
• Excellent verbal and written communication skills.
• Proficiency in database management is a plus.