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Provider Enrollment Specialist

3 months ago

Monroe, United States Blackbird Recruiting Full time

Provider Enrollment

Monroe, NY

$20 - $25 an hour

The provider enrollment team member should meet their responsibilities to enroll and maintain active status of provider enrollment into the carriers for all providers as required by insurance carriers, network management, and state Medicaid regulations.

Responsibility:

  • Maintain individual providers with up-to-date information needed to complete
  • credentialing by the state and govt rules.
  • Maintain the provider information in various systems utilized by different practice
  • groups.
  • Ensure appropriate log-ins are available.
  • Update each provider's database in a timely fashion and according to the carrier's
  • schedule.
  • Complete revalidation requests by payers and carriers.
  • Stay on top of near expiring licensing certificates and/or liability insurance information.
  • Complete credentialing applications for providers for all carriers per state.
  • Complete re-credentialing applications.
  • Work closely with the other teams in MBH to identify and resolve denials and
  • authorizations in claims related to credentialing.
  • Follow up on status and open escalation tickets for submitted or denied credentialing
  • applications.
  • email communication with relevant information to be sent to practice groups by the
  • provider enrollment rep, notifying of delays, more information needed, approvals and
  • such.
  • Attend weekly team meetings
  • Other duties as assigned.
Knowledge/skills/abilities:
  • Detail orientated with above-average organizational skills
  • Able to plan and prioritize to meet deadlines
  • Excellent verbal and written communication
  • Communicates clearly and effectively
  • Excellent reading comprehension
  • Thorough understanding of figuring out processes
  • Computer experience preferred
Core Values:
  • Respectfulness of our unique cultural environment.
  • Confidentiality.
  • Loyalty.
  • Accountability.
  • Thoroughness and attention to detail.
  • Results-oriented, yet industrious.
  • Team Player.
  • Positive and helpful attitude to clients and colleagues.