Provider Enrollment Specialist

3 weeks ago

Grand Rapids, United States Hope Network Full time

Provider Enrollment Specialist

We are helping people overcome. Join us.

Each year at Hope Network, 2,800+ talented professionals serve individuals across 280 unique locations. Some serve by providing hands-on care or medical treatment, others serve by assisting behind the scenes, but they all play an integral part in creating comebacks. Click here to watch what we mean.

Here are just some of the ways Hope Network invests in you for all that you do:

  • Wage starting from $20/hr and up (commensurate with experience)
  • Medical, Vision, & Dental Care
  • 403(b) Retirement Plan
  • Educational Reimbursement
  • Career-Pathing
  • Paid Training
  • Employee Referral Bonus
  • Generous Paid Time Off

With your help, we can take on the challenges, the barriers, the statistics, and the seemingly impossible.

What you’ll be doing

  • Responsible for the enrollment of clinical and professional staff with all payers to assure the timely billing and collections of services rendered.
  • Prepares, processes and maintains new and existing member enrollments and/or disenrollments in accordance with all payers and departmental procedure.
  • Provides timely and professional assistance with internal and external customers regarding all issues related to the provider enrollment process.
  • Interprets and applies the various payer enrollment and eligibility rules and procedures as needed during the enrollment process. Provides assistance as needed to establish and maintain participation with identified payers.
  • Daily: Updates and maintains trackers, rosters, systems, etc. with accurate and consistent provider enrollment information.
  • Completes the disenrollment process of providers in accordance with the requirements as dictated by payers and departmental procedure.
  • Daily: Monitors, researches and reconciles the errors and rejections as identified and with respect to provider enrollment related issues for follow-up in a timely manner to assure successful collection of revenue for services rendered.
  • Serves as the primary liaison between payers and other service providers as needed and required relative to provider enrollment activities.
  • Work cross-functionally with other internal departments to develop or review processes and to resolve issues in a timely manner.

 

Anticipated Work Schedule

Monday-Friday 8:00am-4:30pm

Job Requirements

  • Bachelor’s degree in related field preferred or 3-5 years of current experience in credentialing and/or the provider enrollment process.
  • Knowledge and understanding of the healthcare industry and the enrollment process for commercial insurances; including Federal and State guidelines related to the enrollment process.
  • Demonstrated proficiency PC skills: i.e. proficient with MS Office products including Word. Excel. Project Management. Power Point and Outlook.
  • Ability to multi-task and navigate within an environment that presents multiple needs, demands and changes.
  • Well-developed analytical and problem-solving skills.  Experience with internet; able to perform in-depth searches to find specific websites, guidelines and instructions.
  • Must be able to travel to locations as needed to complete the in- person enrollment process when needed.

Our strength lies in diversity – empowering us to meet the distinct needs of over 34,000 individuals we're honored to serve each year.

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