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Provider Enrollment Specialist
2 months ago
We are seeking a highly organized and detail-oriented Provider Enrollment Specialist to join our team at Integrative Emergency Services, LLC. As a key member of our operations team, you will play a critical role in facilitating the enrollment of healthcare providers with various government and insurance payors, network managed care contracting plans, and third-party billing entities.
Key Responsibilities:- Complete CAQH applications for new and existing providers, ensuring accuracy and attention to detail.
- Prepare and submit applications for new providers to multiple contracts sites, payors, and states, adhering to established enrollment procedures and sound practices.
- Track and follow up on a timely basis to ensure completion of the application process and submission to payors for approval.
- Communicate effectively with clinicians, state payors, insurance carriers, third-party billing companies, and internal staff to expedite the enrollment process.
- Build strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
- Utilize templates or prepare correspondence inserting proper provider and group-related information for submission of applications to payors.
- Work with in-house and third-party billing companies to resolve issues and identify problems with enrollment and claims submission.
- Ensure held A/R enrollments are submitted on a timely basis to avoid risk of claims/adjustments and unnecessary increases in held A/R.
- Meet or exceed divisional and/or corporate enrollment performance standards and meet time-sensitive deadlines.
- High School Diploma
- 3-5 years of previous provider payor enrollment experience or related experience
- Ability to obtain, set up, maintain, and reattest CAQH profiles
- Prior government healthcare payor experience
- Preferred: Bachelor's degree, enrollment experience with both commercial and government plans, multi-state enrollment experience
This role can be performed remotely, and applicants must reside in a state where we operate, including AZ, CO, TX, OK, AL, IN, SC, and FL.
We are committed to creating a diverse, inclusive, and equitable environment and are proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions.
