Provider Enrollment Specialist
3 weeks ago
Nemours is seeking a Provider Enrollment Specialist (hybrid) to join our Nemours Children's Health team in Delaware or Florida.
This position is responsible for administrative and technical duties that require accuracy and attention to detail in the enrollment and reenrollment of our organization and its healthcare providers with all out of state Medicaid plans that we are required to enroll to be reimbursed for services. This position engages with internal and external customers, including physicians and other healthcare providers, administrators, support staff and state representatives. This position requires excellent communication and organizational skills, the ability to prioritize tasks and projects and the capacity to know to act independently but also know when to ask for guidance. Additionally, this position is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered.
- Accurately completes the enrollment/reenrollment processes and manage expirables ensuring the timely and accurate enrollment of providers as outlined by each out of state Medicaid plan for all appropriate healthcare providers as identified through our department policies and our single case agreements.
- Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of hardcopy documents, and document each stage of enrollment/reenrollment process thoroughly.
- Timely and accurately maintain all internal and external systems with appropriate provider information. Systems including, but not limited to, Qlikview, Epic, Echo, PET, CAQH and IGUIDE.
- Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process.
- Cultivate and maintain relationships with state representatives to facilitate the provider enrollment/reenrollment processes.
- Performs follow up with each out of state Medicaid plan to expedite participation approval.
- Respond and resolve problems with out of state Medicaid plans as it relates to denial of services or reimbursement related to enrollment by communicating with all levels of administrative and clinical personnel, managed care, central billing office and state representatives.
- Educate providers, administrators, and support staff regarding the enrollment/reenrollment processes and how it relates to the provider's ability to provide care to out of state Medicaid members.
- Work collaboratively with fellow team members to create, evaluate, and maintain department workflows, processes, policies, and systems.
- Responsible for monitoring the single case agreement report and out of state Medicaid work queue to ensure all providers within our policies are being enrolled and re-enrolled timely.
**Requirements**:
HS Diploma or equivalent. Associate's degree preferred
Minimum of 6 months performing job-related duties in a healthcare environment.
-
Provider Enrollment Specialist
3 weeks ago
Wilmington, Delaware, United States Nemours Full timeNemours is seeking a Provider Enrollment Specialist (hybrid) to join our Nemours Children's Health team in Delaware or Florida.This position is responsible for administrative and technical duties that require accuracy and attention to detail in the enrollment and reenrollment of our organization and its healthcare providers with all out of state Medicaid...
-
Provider Enrollment Specialist
3 weeks ago
Wilmington, United States Nemours Full timeNemours is seeking a Provider Enrollment Specialist (hybrid) to join our Nemours Children's Health team in Delaware or Florida.This position is responsible for administrative and technical duties that require accuracy and attention to detail in the enrollment and reenrollment of our organization and its healthcare providers with all out of state Medicaid...
-
Provider Enrollment Specialist
2 weeks ago
Wilmington, Delaware, United States Nemours Full timeNemours is seeking a Provider Enrollment Specialist (hybrid) to join our Nemours Children's Health team in Delaware or Florida.This position is responsible for administrative and technical duties that require accuracy and attention to detail in the enrollment and reenrollment of our organization and its healthcare providers with all out of state Medicaid...
-
Outreach and Enrollment Specialist
4 days ago
Wilmington, United States Wilmington Community Clinic Full time**Join Wilmington Community Clinic!** Have you ever wanted to be a part of something bigger? Have you ever wanted to make a difference? At Wilmington Community Clinic, here you can. WCC provides quality, non-discriminatory primary care, mental health, dental and women’s health services to improve the health and well-being of all served - regardless of...
-
Provider Specialist
1 month ago
Wilmington, United States Public Health Management Full timePHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers.JOB OVERVIEW:The Provider Specialist performs core functions of the Provider Services Team at the Early Learning Resource Center (ELRC). This...
-
Provider Specialist
1 month ago
Wilmington, United States Public Health Management Full timePHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. JOB OVERVIEW: The Provider Specialist performs core functions of the Provider Services Team at the Early Learning Resource Center (ELRC). This...
-
Director of Enrollment Management
4 weeks ago
Wilmington, United States Gesu School Full timeJob Description: Now celebrating its 30th Anniversary as an independent, Catholic school, Gesu School serves Pre-K through 8th grade students from low-to-moderate income households. The majority of our students reside within the six North Philadelphia zip codes surrounding our school. Gesu School seeks an enthusiastic, engaged, mission-driven individual to...
-
PT Enrollment Services Assistant
3 weeks ago
Wilmington, United States Cape Fear Community College Full timeSalary: $15.00 HourlyLocation : Wilmington - Downtown Campus, NCJob Type: Part Time StaffJob Number: 22-00061Division: Student Services & Enrollment ManagementOpening Date: 04/22/2024Closing Date: ContinuousPosition DescriptionDEFINITIONThis position performs duties in support of Enrollment Services. This position will also serve as a back up to the...
-
Member Outreach Specialist
3 days ago
Wilmington, United States Wayspring Full timeAt Wayspring, we are committed to furthering our value of Equity & Inclusion throughout our recruiting practices. We seek diversity of background and opinion, as we think these attributes improve the performance of our company and are the right thing to do for our communities. We recognize and remove barriers to success within our company and communities. We...
-
PT Enrollment Services Assistant
3 weeks ago
Wilmington, United States Cape Fear Community College Full timeSalary: $15.00 Hourly Location : Wilmington - Downtown Campus, NC Job Type: Part Time Staff Job Number: 22-00061 Division: Student Services & Enrollment Management Opening Date: 04/22/2024 Closing Date: Continuous Position DescriptionDEFINITION This position performs duties in support of Enrollment Services. This position will also serve as a back up to the...
-
PT Enrollment Services Assistant
2 weeks ago
Wilmington, United States Cape Fear Community College Full timeSalary: $15.00 Hourly Location : Wilmington - Downtown Campus, NC Job Type: Part Time Staff Job Number: 22-00061 Division: Student Services & Enrollment Management Opening Date: 04/22/2024 Closing Date: Continuous Position DescriptionDEFINITION This position performs duties in support of Enrollment Services. This position will also serve as a back up to the...
-
Hospital Authorization Specialist
2 weeks ago
Wilmington, United States Nemours Children\'s Health Full timeNemours is seeking a Remote Hospital Authorization Specialist to join our team. Monday through Friday 8:30am-5:00pm. Must be within 1 hour driving distance from Hosptial in Wilmington, DE. The Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent authorizations for all surgical and non-surgical admissions. The...
-
Hospital Authorization Specialist
1 week ago
Wilmington, United States Nemours Children\'s Health Full timeNemours is seeking a Remote Hospital Authorization Specialist to join our team. Monday through Friday 8:30am-5:00pm. Must be within 1 hour driving distance from Hosptial in Wilmington, DE. The Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent authorizations for all surgical and non-surgical admissions. The...
-
Fiscal Support Specialist
3 weeks ago
Wilmington, United States New Hanover County NC Full timeEnsure p-card enrollment forms are filled out correctly, authorize and issue p-cards to users, and maintain files. Manage the p-card accounts: account set-up and closing, account dollar limits and all other account maintenance. Train cardholders on p Support Specialist, Fiscal, Support, Specialist, Vendor, Customer Service, Business Services
-
Hospital Authorization Specialist
3 weeks ago
Wilmington, United States Nemours Full time**Nemours is seeking a Remote Hospital Authorization Specialist to join our team.** **Monday through Friday 8:30am-5:00pm. Must be within 1 hour driving distance from Hosptial in Wilmington, DE.** **Essential Functions: - Ensure request for authorization is timely and handled in accordance with departmental policy and payer requirements. - Accurately verify...
-
Housing Specialist
2 months ago
Wilmington, United States Wilmington Housing Authority Full time**SUMMARY OF POSITION** The Wilmington Housing Authority, public non-profit, federally assisted agency, provides decent, safe and sanitary housing in a businesslike manner with concern for the quality of life for residents. The Authority's clients include low-income families, elderly and disabled individuals. The Section 8 Department is responsible for...
-
Enrollment Agent I
2 weeks ago
Wilmington, United States IDEMIA Full timeOverview IDEMIA is the global leader in identity and security. Our mission is to create a safe and simple future where identity verification is indisputable, and only you can assert your identity. We are a distributed company leveraging the latest technologies to deliver world-class products in the private and public sectors of finance, telecom, identity,...
-
Enrollment Agent I
3 weeks ago
Wilmington, United States IDEMIA Full timeOverview IDEMIA is the global leader in identity and security. Our mission is to create a safe and simple future where identity verification is indisputable, and only you can assert your identity. We are a distributed company leveraging the latest technologies to deliver world-class products in the private and public sectors of finance, telecom, identity,...
-
Onesource Support Specialist
1 week ago
Wilmington, United States Alexion Pharmaceuticals,Inc. Full timeLocation: Wilmington, United States Job reference: R-201785 Date posted: 06/07/2024 **Bilingual in Spanish (Preferred, but not required)** This is what you will do: The OneSource Support Specialist is a high-touch Patient Support Program (PSP) role within the Patient Services Department centered on delivering exceptional and personalized support to...
-
Retention Specialist
3 weeks ago
Wilmington, Delaware, United States The University of North Carolina at Wilmington Full timeDepartment: Undergrad Retention and Student Sup Department Brief Summary of Work for this position: The Retention Specialist is responsible for managing and coordinating retention efforts and data that supports student success outcomes. The incumbent will maintain a current knowledge of appropriate college and academic policies, processes, and...
