Provider Enrollment Specialist

Schedule

Monday - Friday; 8:00am - 4:30pm CST (Central Standard Time)

Location

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).

Job Summary and Qualifications

Seeking a Provider Enrollment Specialist who is responsible for processing enrollments for new and existing individual providers and group practices, such as 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, including escalation to the Provider Enrollment Account Management team or Strategic Pricing and Analytics (SPA) Managed Care Team for resolution.

What You Will Do in This Role

• Ensure provider participation with contracted payors by taking appropriate next actions to complete enrollment, such as completing applications, rosters, and notifications
• Monitor 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
• Appropriately 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

Qualifications You Will Need

• 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

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
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

About HCA Healthcare

We are committed to supporting our colleagues in their career growth and development. We offer a range of opportunities for professional advancement, including training and development programs, mentorship initiatives, and leadership roles. We believe in fostering a culture of continuous learning and improvement, and we encourage our colleagues to take advantage of these resources to enhance their skills and advance their careers.

Equal Opportunity Employer

HCA Healthcare is 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.