Healthcare Provider Enrollment Coordinator
1 month ago
The Provider Enrollment Specialist plays a critical role in ensuring the smooth operation of our revenue cycle management department. This position is responsible for coordinating and managing the enrollment of healthcare providers into various insurance networks, including Medicare, Medicaid, and private insurance plans.
Key Responsibilities:- Enrollment Management: Ensure accurate and timely completion of provider enrollment applications to Medicare, Medicaid, and commercial insurance carriers.
- Credentialing Coordination: Assist in gathering necessary provider documentation for credentialing and re-credentialing processes with payers.
- Database Maintenance: Maintain and update provider enrollment records in internal systems, ensuring accuracy and timely tracking of payer updates and credentialing statuses.
- Payer Communication: Serve as the primary liaison between the healthcare provider and payer networks to resolve enrollment issues, delays, or requests for additional information.
- Compliance: Ensure that all enrollment and credentialing processes adhere to federal, state, and payer-specific regulations.
- Provider Support: Act as the point of contact for providers and administrative staff regarding enrollment status and credentialing inquiries.
- Follow-Up: Regularly follow up with payers to confirm enrollment status, address issues, and expedite the approval process.
- Reporting: Provide management with regular updates and reports on the status of provider enrollments.
- Education: High school diploma or equivalent; Associates degree in healthcare administration, business, or a related field preferred.
- Experience: Minimum of 2-3 years of experience in provider enrollment, credentialing, or revenue cycle management within the healthcare sector.
- Knowledge: Familiarity with Medicare, Medicaid, and commercial insurance payer enrollment processes; understanding of post-acute care services and related credentialing requirements.
- Technical Skills: Proficiency with provider enrollment and credentialing software systems, as well as Microsoft Office Suite (Excel, Word).
- Organizational Skills: Strong ability to manage multiple tasks, prioritize, and meet deadlines in a fast-paced environment.
- Communication Skills: Excellent written and verbal communication skills to interact with providers, payers, and internal teams.
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