Job Description

The Provider Enrollment Specialist facilitates the physician and mid-level enrollment applications process for Medicare, Medicaid, and commercial payers. This role is responsible for preparing and submitting supporting documentation for the purpose of enrolling individual physicians and mid-levels. This position is also responsible for follow up on the status of applications and tracking the progress on all pending applications.

Prepares Enrollment Documentation and Applications – 80%

• Initiates the payer enrollment process with all payers identified by client for enrollment
• Completes all required applications for submission to payers
• Coordinates credentialing data needed for enrollment, contracting, and other related purposes
• Creates providers in CAQH ProView as necessary
• Enters and updates clinician information in the database
• Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement
• Focuses on enrollment related continuous process improvement to ensure optimal operation

Internal and External Liaison - 20%

• Acts as liaison to CVO, clients, outside agencies, physicians, medical practice groups, health plans, etc.
• Responds to internal and external inquiries on routine enrollment and contract matters
• Works closely with clinicians to obtain missing documentation pertaining to provider enrollment

SECONDARY FUNCTIONS (IF APPLICABLE)

• May work on special projects or other duties as assigned

SUPERVISORY/BUDGETARY/EXTERNAL COMMUNICATION RESPONSIBILITY

• May communicate with clinicians, clients, and insurance providers

QUALIFICATIONS – EDUCATION, WORK EXPERIENCE, CERTIFICATIONS

• High School Diploma or equivalent required. Bachelor’s Degree preferred.
• 3+ years of related experience required

KNOWLEDGE, SKILLS, AND ABILITIES

• Ability to adhere to and exhibit the Company Values at all times
• Working knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Teams
• Working knowledge of CMS, PECOS, CAQH, NPPES payer credentialing software
• Working knowledge of PDF editing software
• Working knowledge of Salesforce
• Ability to build relationships at all levels - internally and externally
• Strong customer service mindset
• Strong organizational and time management skills
• Ability to work independently
• Strong communication skills - both oral and written
• Ability to work with sensitive information and maintain confidentiality
• Solid critical thinking and problem-solving skills
• Strong attention to detail and accuracy

KEY COMPETENCIES REQUIRED

• Business Insight
• Interpersonal Savvy
• Customer Focus
• Communicates Effectively
• Balances Stakeholders
• Organizational Savvy
• Action Oriented
• Instills Trust
• Resourcefulness
• Situational Adaptability
• Collaborates

PHYSICAL, MENTAL, WORKING CONDITION, AND TRAVEL REQUIREMENTS

• Typical office environment - sedentary with typing, writing, reading requirements
• May be able to sit or stand
• Speaking, reading, writing, ability to use a telephone and computer
• Ability to exert up to 10 lbs. of force occasionally
• Ability to interpret various instructions
• Ability to deal with a variety of variables under only limited standardization

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