Provider Enrollment Specialist

2 weeks ago

Fairport, New York, United States Credentialing East Woodcliff Full time
Job Overview

Position Summary

The Provider Enrollment Specialist is responsible for executing all credentialing functions related to physicians and the organization. This includes managing physician licensure, handling malpractice claims, updating professional profiles, and overseeing health plan contracts while ensuring compliance with continuing education requirements.

Key Responsibilities

  • Efficiently credential and enroll new physicians with various insurance carriers.
  • Assist in the comprehensive provider enrollment process for the organization.
  • Maintain an accurate and up-to-date database of physician participation details.
  • Generate reports on expiring credentials and gather necessary documentation for enrollment.
  • Foster positive relationships between payers and healthcare providers.
  • Notify management of any challenges encountered in the credentialing or enrollment processes.
  • Provide necessary documentation to customers upon request.
  • Guide physicians on tasks required to uphold their licensure and credentials.
  • Track continuing education credits and inform physicians of any deficiencies.
  • Manage the software utilized for maintaining physician credentialing information.

Compliance and Quality Assurance

  • Deliver accurate and comprehensive information to all stakeholders.
  • Adhere to all compliance standards and organizational policies.
  • Respond promptly to customer inquiries and know how to source information effectively.
  • Maintain professional communication and rapport with customers.
  • Exhibit professionalism in challenging situations and know when to escalate issues to management.

Service Delivery

  • Support the objectives of the management team and healthcare providers.

Team Collaboration

  • Encourage teamwork and assist colleagues as needed.

Minimum Qualifications

  • At least 3 years of experience in provider enrollment or credentialing.
  • Ability to initiate and maintain effective provider records.
  • High school diploma or equivalent is required.
  • Proficient typing and filing skills; must demonstrate professional judgment and initiative.
  • Physical requirements include normal office activities such as filing, typing, and occasional lifting of up to 30 pounds.
  • Intellectual capabilities include clear verbal communication, basic math skills, and organizational abilities.
  • Working conditions involve a balance of sitting and standing, with significant time spent on computers and phone communications.

Quality Standards

  • Maintain professionalism and cooperation with all levels of staff and external parties.
  • Demonstrate initiative, integrity, and confidentiality in all tasks.
  • Comply with all relevant employment laws and regulations.
  • Follow safety and privacy standards at all times.
  • Adapt to new tasks and systems as required.
  • Exhibit punctuality and maintain satisfactory attendance.
  • Complete job responsibilities efficiently and effectively.

Physical Demands

This role may require sitting, standing, walking, and other physical activities, including the ability to use office equipment and lift up to 10 pounds occasionally.

Work Environment

Hybrid work setting, combining office and potential remote work.

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