Enrollment Specialist

4 weeks ago

Temple, United States Integrated Resources, Inc Full time

Job Title : Enrollment Specialist

Job location : Temple TX

Job duration : 5 months (Temp to Perm)

Shift Timings : Mon-Fri 8 am - 5 pm

Job Description:

Roles and Responsibilities:

· Responsible for entering and maintaining provider demographic and contractual data within the claims processing system and working with various departments to answer questions regarding information configured within the provider database.

· Maintains provider database, utilizing credentialing data, the National Plan & Provider Enumeration System (NPPES) and other data sources to ensure data integrity within the claims processing system.

· Works in conjunction with Network Development to enter new contracts into the system and make modification to existing contracts.

· Collects IRS W-9 forms from providers to validate/update configured information .Collaborates with enrollment operations to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP).

· Assists in the selection of the appropriate pricing template to apply to contracts. Works in conjunction with the Compliance Department to update provider records as appropriate when notified of credible allegations of fraud and identify any claims paid during the alleged period.

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