Provider Enrollment Specialist

Job Duties

• Prepare and submit enrollment applications and supporting documents for new and existing providers.
• Maintain and update provider information in databases and systems, ensuring accuracy of details like licenses, certifications, and addresses.
• Verify provider credentials and ensure all paperwork meets the requirements of various health plans and government payers.
• Act as a liaison by responding to inquiries from providers and payers, and follow up to expedite the enrollment and re-enrollment process.
• Research and resolve issues that delay enrollment, such as missing information on applications.
• Organize and maintain files for all provider enrollments and other related documentation.

Requirements

• A strong understanding of healthcare regulations, payer requirements, and provider enrollment processes.
• Familiarity with medical terminology and basic billing practices.
• Technical proficiency in provider enrollment software, credentialing databases such as CAQH, and common office applications like Word and Excel.
• Excellent attention to detail and strong organizational skills.
• Effective communication to manage complex documentation and coordinate with multiple stakeholders.
• Prior experience in a healthcare setting with at least three (3) to five (5) years of experience, particularly in credentialing, managed care, or claims processing.

Salary

$22.00 - $26.00 per hour