Provider enrollment specialist

1 month ago

Syracuse, United States Aspen Dental Full time

The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 46 states in three distinct categories: Dental care, urgent care, and medical aesthetics. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. ADMI provides a comprehensive suite of centralized business support services that power the impact of four consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care and Chapter Aesthetic Studio. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

Job Summary

The Provider Enrollment Specialist plays a vital role within our Payor Strategy Team. This position will be responsible for ensuring that Aspen providers are enrolled with assigned dental plans and remain active. The successful candidate will report to the Provider Enrollment Manager.

Essential Responsibilities

  • Submit and process initial enrollment applications and re-enrollment applications to assigned plans.
  • Proactively maintain files and complete re-enrollment to avoid any lapse in provider participation.
  • Maintain organized and complete files of all relevant documentation + applications.
  • Responsible for following up on outstanding enrollment information and/or paperwork from providers to ensure timely processing.
  • Utilize knowledge + skill set to complete all enrollment documentation with a high degree of accuracy to avoid denials.
  • Track and follow up on enrollment or re-enrollment applications with payers until provider enrollment or re-enrollment is completed.
  • Responsible for provider file maintenance with the payers, including but not limited to provider name changes, required attestations and any other payer required data.
  • Establish and maintain professional working relationships with key contacts, both internal (Revenue Cycle Management, Providers, Credentialing, etc) and external (dental plans).
  • Work closely with RCM and Operations to ensure reimbursement is accurate and quickly resolve any escalated items.
  • Demonstrate exemplary customer service to our plan partners, providers and other TAG employees.
  • Meet targeted enrollment deadlines.
  • Communicate risk to leadership as soon as identified.
  • other duties as requested.

Requirements/Qualifications

  • High School Diploma or equivalent required, College Degree preferred.
  • 5 years of relevant dental or insurance plan experience
  • Excellent verbal & written communications
  • Excellent time management, prioritization and organizational skills a must.
  • Detail oriented with a strong level of analytical, and problem-solving skills
  • Proficient use of Microsoft Office Suite, particularly Excel

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