Provider Enrollment Specialist

4 weeks ago

Concord, United States Conduent State Healthcare, LLC Full time

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Provider Enrollment Specialist (ONSITE)
Hours:8:00 AM- 4:30 PM; Monday through Friday
 
Hourly rate - $17/hr
Job Description:
Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates. This involves accurate and timely entry of provider data, including provider applications and contact information, status changes, revalidations. It also includes verification of all the credentialing criteria for providers that have applied to NH Medicaid through initial application, and following up with providers as needed to obtain information for the enrollment process. There will be a need to liaison with the Systems Teams as the Provider Enrollment IT Operations Specialist. 
 
Job Duties and Responsibilities: 

Enter and maintain provider applications, revalidations, and updates into the system.
Enter and maintain all provider information into database.
Verify prospective and current providers’ license, NPI, and other required enrollment documentation.
Verify accurate banking and billing information.
Perform ongoing research to correct data so that it does not create duplicate providers, locations, and participation statuses.
Maintain provider information by reviewing, entering, and following up on missing information.
Track contract applications status.
Ensure all files have a welcome, denial, or term letter as appropriate.
Meet required turnaround times and accuracy rates.
Keep up-to-date provider enrollment process and records, and track provider participation levels.
Outreach providers as a result of mail being returned undelivered to XYZ COMPANY.
F Update the system and the credentialing database to reflect approvals, denials, and/or terminations.
Facilitate provider-related research based on suspended claims, Call Center escalations and other feedback opportunities.
Assists call center agents, all internal departments, providers, and potential providers with resolving Provider Enrollment issues and inquiries
Meets quality controls and production standards of the Provider Relations Department
Assist with other duties as assigned
Communicate with the Systems Team on identified Tech Errors in MMIS

 
Incumbent should possess the following skills: 

System application aptitude to communicate and work with the Systems Team on MMIS technical errors during enrollment and provider data base management.
Previous experience working with files or the collection and coordination of data (preferred).
Proficient in the use of Excel.
Experience with general computer software (Word, Outlook required).
Ability to learn new software programs quickly.
Good basic math skills.
Excellent customer service skills.
Excellent verbal and written communication skills.
Professional and effective interaction skills with co-workers, clients, and providers.
Proven ability to work well individually and as a team member.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Ability to make independent decisions.
Strong attention to detail.
Strong business acumen.
Ability to adapt to constantly changing environment.

 
Required Experience:

High school diploma or equivalent; Associate’s degree preferred.
1–2 years of experience in business environment.

 
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information.  For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated pay for this role is $17.00 per hour.Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy. At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

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