Provider Enrollment Specialist

Highlights

• Competitive compensation and benefits packages
• · Continuous professional development and learning opportunities
• · Regular engagement activities and events

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PROVIDER ENROLLMENT SPECIALIST

Work for our global clients and immerse in our rich and diverse company culture where you can thrive, grow and be #DecidedlyDifferent!

ROLE OVERVIEW

We are looking for a Provider Enrollment Specialist to be part of our team.

• The role is responsible for coordinating, monitoring and maintaining the credentialing/provider enrollment and re-enrollment process in a timely and compliant manner, in accordance with departmental procedures, with all contracted commercial and government payors. The specialist will maintain communication with Internal/External customers, ensuring accuracy of provider applications and creating efficiency for the on-boarding process.
  

MAIN RESPONSIBILITIES

• Obtain all provider information and documentation necessary for health plan enrollment, including Medicare and Medicaid.
• Manage and follow up on submission and processing of applications within the appropriate timeframe with all health plans/payors.
• Communicate with internal and external customers to ensure all requirements are completed accurately and timely, providing excellent customer service to all internal and external parties.
• Ensure all internal and external databases are updated and current.
• Ensure primary source verifications occur for internal processing, as well as external customers.
• Maintain necessary reporting and documentation for expiration monitoring and re-enrollment processes for locations and providers. Communicate expiring documents to providers and assist as necessary to ensure that updated documentation is collected.
• Run reports and distribute to appropriate individuals regarding approved providers and licensed professionals and projected start dates.
• Process all status changes and terminations with respect to payors.
• Cross-train to support the Licensing and Credentialing team.

REQUIREMENTS

• Associate's degree or equivalent from two-year college or technical school;
  
• 6 months to one-year related experience and/or training; or equivalent combination of education and experience.
  
• Willing to work a night shift schedule.
  
• Must be able to work on our site on 6th Floor Tower 1Rockwell Business Center, Ortigas