Provider Enrollment Specialist-Day(FT)

About the role

Position: Provider Enrollment Specialist
Salary: Based on YOE
Work Life Balance: Full-Time | Day Shift
Location/Department: Chillicothe

Responsibilities

• Perform the administrative and technical duties in the enrollment and re-enrollment activities for all Adena Medical Group providers and Adena Health System facilities.
• Enroll and re-enroll healthcare providers and facilities as identified through department policies and network reimbursement and delegated contracts.
• Maintain detailed provider enrollment files in electronic format, including scanned documents, and document each stage of the enrollment process.
• Maintain internal systems with appropriate provider and network participation information.
• Maintain good working relationships with Adena Medical Group providers, practice managers, Medical Staff Services, and support staff to facilitate the enrollment process.
• Develop and maintain relationships with assigned Payors, Governmental, and Network Representatives to facilitate the enrollment/re-enrollment processes.
• Resolve problems with provider network participation, such as denials of covered services or reimbursement, by working with administrative and clinical personnel and network representatives.
• Collaborate with fellow team members to improve department workflows, processes, policies, and systems.
• Maintain standardized rosters for submission to payers with delegated credentialing agreements with AHS.
• Remain compliant and up-to-date with all payer enrollment industry standards and expectations.

Requirements

• High School Diploma or GED
• Associates Degree in Business Administration or related field
• De-escalation training within 6 months
• Required experience: 1-2 years administrative healthcare experience
• Payer enrollment application experience to include, but not limited to, PECOS, CAQH, CMS, BWC functions/requirements
• Excellent written and verbal communication skills and detail-oriented
• Ability to work independently and organize tasks effectively

Qualifications

• Required certifications: De-escalation training within 6 months
• Preferred certifications: None specified

Skills

• Excellent written and verbal communication skills
• Detail-oriented
• Ability to work independently and organize tasks effectively
• Collaborative and project management skills

Benefits

Reliable compensation
Strong healthcare coverage options
3.5% retirement match with automatic annual increase
PTO that grows with tenure
Visible leadership impact within a regional health system

Pay

Based on YOE

Schedule

Full-Time | Day Shift