Provider Enrollment Specialist
Monday to Friday, 8:00 AM to 5:00 PM. Pay range: $60,500+ per year. Salary offers are based on relevant skills, training, experience, education, certifications, and market factors. Successful candidates may be eligible for annual performance bonus compensation.
Benefits
- Day 1 Medical, supplemental health, dental & vision for full-time employees (30+ hours)
- Best-in-class well-being programs
- Annual, no-cost health assessment program (Blueprint for Wellness®)
- healthyMINDS mental health program
- Vacation and Health/Flex Time
- 6 Holidays plus 1 "MyDay" off
- FinFit financial coaching and services
- 401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
- Employee stock purchase plan
- Life and disability insurance, plus buy-up option
- Flexible Spending Accounts
- Annual incentive plans
- Matching gifts program
- Education assistance through MyQuest for Education
- Career advancement opportunities
About the role
Manage, monitor, and complete activities related to Provider Enrollment applications, revalidation updates, and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS), Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers, for Quest Diagnostics, its subsidiaries, joint ventures, and their respective testing facilities. Drive process compliance, controls, and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.
Responsibilities
- Review, prepare, and submit requests for Medicare, Medicaid, and Health Plan payers, including completion of:
- Provider enrollment applications
- Revalidation requests
- NPI enrollments
- Licensure updates
- CAQH physician credentialing
- Health plan credentialing
- Attestations and disclosures of ownership
- Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations, and Optum to successfully complete enrollment requests and related activities
- Engage with payers directly to discuss enrollment issues, inquiries, updates, and due dates of enrollment applications
- Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer-defined enrollment/re-enrollment deadlines
- Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
- Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and the DocuSign eSignature tool
- Accurately and efficiently submit enrollment and credentialing applications
- Effectively manage and update the status of enrollments by way of case creation and management
- Effectively communicate with agencies, health plans, and internal stakeholders on the status of enrollments and credentialing applications
Requirements
- 3+ years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
- Relevant experience in large, complex organizations, commercial labs, or healthcare organizations
- Bachelor’s Degree (Preferred)
Skills
- Strong analytical and problem-solving skills
- Strong interpersonal skills; ability to work with external clients and multiple internal levels
- Ability to handle confidential or sensitive information with discretion
- Strong written & verbal communication
- Strong attention to detail
- Strong technical skills in MS Word and Excel
- Able to multi-task and perform in a fast-paced environment
- Lominger’s Competencies:
- Customer Focus
- Organizational Savvy
- Learning on the Fly
- Problem Solving
- Dealing with Ambiguity
- Drive for Results
- Competencies:
- Action oriented
- Business acumen
- Customer Focused
- Interpersonal savvy
- Organizing
- Priority Setting
- Time management