Provider Enrollment Specialist

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Job description

Under the direction of the Provider Enrollment Manager, the Provider Enrollment Specialist facilitates the health plan application process for new and contracted providers through each stage of the enrollment process for participation with all commercial and/or government payers.

The Provider Enrollment Specialist performs duties independently and determines priorities based on department expectations and availability of credentialing information and documents. Coordinates with Medical Staff Services on the credentialing process. Applies for malpractice insurance through the Risk Management/Legal department. Initiates enrollment of employed and contracted providers by inputting credentialing information into the CAQH database for initial insurance credentialing as well as for re-credentialing. Maintains CAQH database with updates and periodic reviews. Maintains database of CAQH and NPI usernames and passwords. Collaborates with PHO Director of Provider Services on the IPA application for participation in the IPA and NEQCA health plan contracts. Communicates to the leadership team, providers, office managers, billers, schedulers and the referral team on health plan approval updates via the provider status report. Responsible for other related clerical duties as required: faxing, filing, photocopying and scanning.

Bachelor's degree or an equivalent combination of training and experience.

3-5 years business experience with knowledge of the medical staff credentialing process, and both medical and behavioral health plan enrollment experience a plus.

Good interpersonal, organizational communication skills, both verbal and written. Self-motivated, detail oriented, and able to work well as a team member. Telephone skills a must.

Ability to prioritize and respond effectively to multiple tasks and / or changing job expectations. Must be proficient with Microsoft Office and be able to work with spreadsheets.

The Provider Enrollment Specialist role could be part time (3 days/week) or full time with coverage in the Credentialing Office included (+2 days/week).