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Provider Enrollment Specialist

2 months ago

Phoenix, Arizona, United States Alpine Solutions Group Full time

Essential Qualifications:

  • Bachelor's degree required
  • Proven experience with SQL reporting
  • Familiarity with claims clearinghouse operations
  • Capability to supervise a team of three
  • Experience in managing databases, including authorization to add payors to systems and overseeing backend operations
  • Solid understanding of healthcare billing applications
  • Experience in integrating new providers into software databases
  • Comprehensive knowledge of EDI standards in healthcare:
    • HIPAA
    • ACA
    • X12
    • ANSI standards
    • 837 and 835 reimbursement processes
    • 270 and 271 claims standards
  • Technical expertise in payor enrollment, understanding of healthcare reimbursement, payor policies, and regulatory frameworks
  • Knowledge of electronic claims and payment transactions

Preferred Qualifications:

  • Experience with software such as Zoll or Tritech
  • Familiarity with Centricity EDI billing software

Daily Responsibilities:

Alpine Solutions Group is seeking a dedicated Data Provider Enrollment Specialist to enhance our dynamic healthcare operations. This role involves establishing, maintaining, and supporting EDI processes, which encompasses business analysis, configuration, coding, quality assurance testing, and comprehensive documentation. The Specialist will leverage their professional background in analysis, process design, modifications, configuration, data mapping, and the maintenance of integrated systems and software solutions.