Provider Enrollment Specialist

2 weeks ago

Little Rock, United States Arkansas Children's Full time

**Work Shift:**

Day Shift

**Time Type:**

Full time

**Department:**

CC017090 Patient Financial Services

**Summary:**

Monday - Friday, 8:00 a.m. - 5:00 p.m. ▬ Hybrid

The Provider Enrollment Specialist facilitates the applications from a new/existing provider's through all stages in order to enroll or re-validate the provider's with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas

**Additional Information:**

**Experience Requirements:**

**- Strong communication skills as you will be speaking with payers, facilities, medical billing staff, and/or clients weekly via telephone**

**- Knowledge of medical credentialing and privileging procedures and standards**

**- Willingness to establish and maintain effective work relationships with providers, payers, MSOs, co-workers, supervisors, and/or managers**

**- Ability to analyze, interpret, and draw inferences from research findings and prepare reports**

**- Ability to work independently in a fast-paced environment while remaining calm and professional**

**- Database management skills, including querying, reporting, and document generation**

**- Must be able to multi-task**

**- Excellent organizational skills and must be detail-oriented**

**- Proficiency in Microsoft Office**

**- Strong computer and typing skills**

**- Positive, friendly, approachable disposition**

**- Ability to work with multiple priorities**

**Required Education:**

Bachelor's degree from four-year college or university; Or four years related experience and/or training; or equivalent combination of education and experience.

**Recommended Education:**

Bachelors Degree or Equivalent Experience

**Required Work Experience:**

**Recommended Work Experience:**

Related Field - Previous experience in a health care setting

**Required Certifications:**

**Recommended Certifications:**

**Description**

1.Conducts the enrollment process and maintains provider information in MD Staff platform

2. Adheres to deadlines and enrollment schedules by tracking files through all stages

3. Communicates with providers, payers, MSOs via email, phone, Teams and mail

4. Helps the department move to paperless by centralizing all provider data gathered in software

5. Maintains confidentiality and responsibility for all enrollment files through the process

6. Maintain an organized database of physician information, ensuring accuracy and completeness.

7. Ensure that all enrollment activities adhere to healthcare regulations and organizational policies.

8. Collaborate with internal departments, including HR, legal, and billing, to facilitate the enrollment process.

9. Address and resolve enrollment-related issues and discrepancies promptly. Monitor and meet goals established for KPI metrics

10. Generate reports and documentation related to physician enrollment, as needed. Maintaining work ques for provider enrollment within HIS system.

11. Other duties as assigned.

Arkansas Children's provides equal employment opportunity to all persons without regard to age, race, color, religion, national origin or citizenship status, disability, military status, sexual orientation, gender identity or expression, pregnancy or any other category protected by federal, state and local laws. Further, Arkansas Children's will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

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