Provider Enrollment Specialist

1 week ago

Concord, New Hampshire, United States Conduent State Healthcare, LLC Full time
Job Title: Provider Enrollment Specialist

Conduent State Healthcare, LLC is seeking a highly skilled Provider Enrollment Specialist to join our team. As a key member of our enrollment operations team, you will play a critical role in ensuring the timely and accurate enrollment of healthcare providers into our system.

Key Responsibilities:
  • Enter and maintain provider applications, revalidations, and updates into our system.
  • Verify prospective and current providers' license, NPI, and other required enrollment documentation.
  • Verify accurate banking and billing information.
  • Perform ongoing research to correct data and prevent duplicate providers, locations, and participation statuses.
  • Track contract applications status and ensure all files have a welcome, denial, or term letter as appropriate.
  • Meet required turnaround times and accuracy rates.
  • Keep up-to-date provider enrollment process and records, and track provider participation levels.
  • Outreach providers as a result of mail being returned undelivered.
  • Update the system and credentialing database to reflect approvals, denials, and/or terminations.
  • Facilitate provider-related research based on suspended claims, Call Center escalations, and other feedback opportunities.
  • Assist call center agents, internal departments, providers, and potential providers with resolving Provider Enrollment issues and inquiries.
Requirements:
  • High school diploma or equivalent; Associate's degree preferred.
  • 1–2 years of experience in a business environment.
  • System application aptitude to communicate and work with the Systems Team on MMIS technical errors during enrollment and provider data base management.
  • Previous experience working with files or the collection and coordination of data (preferred).
  • Proficient in the use of Excel.
  • Experience with general computer software (Word, Outlook required).
  • Ability to learn new software programs quickly.
  • Good basic math skills.
  • Excellent customer service skills.
  • Excellent verbal and written communication skills.
  • Professional and effective interaction skills with co-workers, clients, and providers.
  • Proven ability to work well individually and as a team member.
  • Ability to prioritize and organize multiple tasks.
  • Ability to remain organized with multiple interruptions.
  • Ability to make independent decisions.
  • Strong attention to detail.
  • Strong business acumen.
  • Ability to adapt to constantly changing environment.
What We Offer:
  • Competitive hourly rate of $17.00.
  • A variety of benefits, including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time.

Conduent State Healthcare, LLC is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

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