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Provider Data and Enrollment Specialist II
4 months ago
Virginia Beach, VA
Overview
Work Shift
First (Days) (United States of America)
Sentara Health Plans is currently recruiting for a Full-Time Day Shift,
Provider Data and Enrollment Specialist II, Remote position.
The primary role of the Provider Data Enrollment Specialists II is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider setup to initiate credentialing, provider record updates and edits, processing provider terminations, and researching and resolving provider setup issues in the applicable systems. This position is also responsible for remediating capitation-related provider data issues and regulatory-related research and updates. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.
Job Requirements
- Bachelor's Level Degree preferred
- Health Insurance Experience 3 years required
- Understanding health claims processing preferred
Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.
Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
Sentara Health Plans is the health insurance division of Sentara Healthcare.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.
With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve
keywords: Health Insurance, Provider Network, Contract Data, Health Claims, Indeed, Monster
Job Summary
The primary role of the Provider Data Enrollment Specialists II is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider setup to initiate credentialing, provider record updates and edits, processing provider terminations, and researching and resolving provider setup issues in the applicable systems. This position is also responsible for remediating capitation-related provider data issues and regulatory-related research and updates. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.
BA preferred. Minimum of 3 years experience in healthcare insurance working with provider, network, or contract data; or a combination of education and experience, which would provide an equivalent background
Understanding health claims processing is a plus
Qualifications:
Insurance
Skills
Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
