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Healthcare Provider Enrollment Specialist
2 months ago
The Provider Enrollment Specialist is a crucial role at Altea Healthcare, responsible for coordinating and managing the enrollment of healthcare providers into various insurance networks. This position plays a vital part in ensuring that providers are properly credentialed, enrolled, and maintained within payer systems, enabling smooth claims processing and reimbursement.
Key Responsibilities:- Enrollment Management: Complete and submit provider enrollment applications to Medicare, Medicaid, and commercial insurance carriers, ensuring accuracy and compliance with all required documentation.
- 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, with a particular focus on post-acute care.
- 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, ensuring transparency and timely problem resolution.
- Collaborative Efforts: Work closely with billing and revenue cycle teams to ensure providers are fully enrolled and credentialed to facilitate proper claims processing.
- Education: High school diploma or equivalent; Associate's 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.
- Detail-Oriented: High attention to detail and accuracy in managing enrollment applications and ensuring compliance with payer requirements.
- Experience working with Medicaid, Medicare, and commercial insurance networks.
