Provider Enrollment Specialist

About the role

The Provider Enrollment Specialist assists with all aspects of the insurance provider enrollment process for the organization. Enrollment includes both facility and professional providers participating in government programs and commercial payer networks. The role maintains excellent relations and liaisons between payers, clinics, and providers to ensure participation status is managed in a timely and accurate manner. The Specialist supports compliance and Principles of Responsibility, maintains confidentiality, protects organizational assets, and exhibits ethics and integrity.

Responsibilities

• Complete insurance enrollment applications following the organization's standards, state and federal regulations, guidelines, procedures, and laws required in the credentialing process.
• Responsible for initial credentialing with insurance companies.
• Ensure the credentialing and re-credentialing process is completed promptly for individual providers and the organization.
• Notify appropriate managers of any credentialing issues, status on outstanding applications, changes with contracted insurance companies, and new plans within the company’s service delivery area.
• Handle telephone communications to answer credentialing and staff questions regarding provider participation, credentials, and documentation.
• Obtain signatures in the field as required to complete the credentialing process.
• Adhere to the safety policy of MCR Health.
• Perform other duties as assigned from time to time.

Requirements

• High School Graduate or GED equivalent required.
• Two (2) years of Healthcare Insurance experience.
• Provider Enrollment experience preferred.
• Working knowledge of Medicaid, Medicare, and private insurance.
• Basic Microsoft Excel skills; advanced skills preferred.
• Experience and/or education in computer data entry.
• Strong interpersonal skills in written and oral communication, problem-solving, and teamwork.
• Excellent grammar skills.
• Ability to meet deadlines and complete assignments promptly.
• Medical terminology knowledge is helpful.
• Ability to work with minimal supervision.
• Courteous, helpful, and able to maintain patient confidentiality.

Benefits

MCR Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.