Provider Enrollment Specialist

Job Summary

The Provider Enrollment Specialist is responsible for processing enrollments for new and existing individual providers and group practices, including initiating new enrollments with Commercial and Governmental payors and reporting demographic or other provider changes. Other duties include follow-up on open applications with providers or payors, escalating issues to the Provider Enrollment Account Management team or Strategic Pricing and Analytics (SPA) Managed Care Team for resolution, initiating contact with payors and practices via telephone or electronic methods, and updating and maintaining data in appropriate Provider Enrollment systems.

Qualifications

• 1 year of related experience required, such as Medicare/Medicaid Enrollment or Managed Care Enrollment
• Relevant education may substitute experience requirement
• Knowledge of National Plan and Provider Enumeration System (NPPES) and Council for Affordable Quality Healthcare (CAQH) preferred

What You Will Do

• Ensure provider participation with contracted payors by taking appropriate next actions to complete enrollment, such as completing applications, rosters, and notifications
• Maintain inventory
• Escalate items to other areas outside of department as needed
• Work with payors and providers to ensure compliance with enrollment process
• Initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment and billing errors, utilizing proper customer service protocol
• Update and maintain data in appropriate Provider Enrollment systems while ensuring accuracy and data integrity
• Review correspondence received and perform appropriate action to resolve or escalate payor application denials
• Meet and maintain established departmental performance metrics for production and quality
• Maintain working knowledge of workflow, systems, and tools used in the department

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing

Note: Eligibility for benefits may vary by location.

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If you find this opportunity compelling, we encourage you to apply for our Provider Enrollment Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.