Provider Enrollment Specialist

You're more valuable than ever – And that's just how we'll make you feel.

Job Summary 
The Provider Enrollment Specialist is responsible for managing and tracking provider enrollment across multiple payers and states. This role ensures enrollment data is accurate and current in internal systems and supports the revenue cycle team by identifying and resolving claim issues related to provider enrollment. The Provider Enrollment Specialist works closely with internal teams, external partners, and payers to address enrollment-related claim issues, credentialing discrepancies, ensure compliance, and improve enrollment workflows.

Qualifications 
Education Required:  

• High School Diploma or GED 
Licenses/Certifications Required:  

• None 

Work Experience Required:  

• 2+ years of experience in healthcare and/or customer service or similar role 

Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.: 

• Associates degree 

• Knowledge of electronic Medical Record systems (EPIC and EClinical Works)

Knowledge, Skills, and Abilities 

• Strong understanding of Medicare, Medicaid, and commercial payer enrollment processes and credentialing requirements. 

• Skilled in Microsoft Office Suite, particularly Excel and Word, for data tracking, reporting, and documentation. 

• Excellent written and verbal communication abilities, with a professional and collaborative approach to engaging team members, supervisors, joint venture partners, providers, and insurance payers. 

• Ability to build relationships and work effectively across departments, including operations, provider enrollment, and other revenue cycle teams. 

• Capable of facilitating and contributing to group discussions and cross-functional meetings. 

• Demonstrated ability to handle sensitive information (personal identifying information) in accordance with HIPAA and other regulatory standards. 

• Comfortable working in a fast-paced, evolving environment with shifting priorities and deadlines.

• Skilled in identifying trends, resolving issues, and recommending process improvements related to enrollment and claims. 

• Strong attention to detail in tracking enrollment status, maintaining records, and ensuring data accuracy. 

• This role involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.

Essential Duties and Responsibilities 

• Track enrollment status with various payers (Medicare, Medicaid, commercial insurers). 

• Maintain accurate and up-to-date records of provider enrollment status and credentials in internal and external systems and tracking tools. 

• Serve as the liaison between providers, team members, joint venture partners, and payers regarding enrollment and provider and facility credentialing issues. 

• Investigate and resolve claim denials and rejections related to enrollment discrepancies. 

• Collaborate with the enrollment submission team to obtain updates and clarify enrollment timelines. 

• Collaborate with the billing team to ensure claims are submitted for enrolled providers to minimize denials and payment delays. 

• Identify trends in enrollment-related claim denials and escalate persistent issues for resolution to the JV partner, leadership and/or payer. 

• Assist with documentation and reporting on enrollment progress for internal and external audits. 

• Ensure compliance with state and federal regulations, as well as payer-specific guidelines. 

• Support stakeholders by providing timely and accurate updates on provider participation status. 

• Identify trends and process improvements to streamline enrollment and claim workflows.

GoHealth Core Values 
GoHealth's Core Values, listed below, are essential functions of this position: 

• Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront. 

• Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency through process and other forms of innovation. 

• Diversity & Inclusion: Fosters diversity and inclusion, to be able to better understand team members, our customers and partners.  Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed. 

• Courage & Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect. 

• Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities.

Physical Requirements 

• Office Environment: Tasks may be conducted within a climate-controlled office setting. 

• Physical Activity: The role may require the ability to lift, carry, push, or pull materials, supplies, and equipment (up to 10 lbs.) Duties typically involve a combination of sitting, standing, and walking, with frequent changes in position. 

• Travel: Travel may be required, including travel between Company locations and out of town destinations as needed. 

• Safety Equipment: May require the use of safety equipment for infection prevention.

Note: This Job Description is not inclusive of all the duties of the position. You may be asked by Leaders to perform other duties. Leadership may revise this job description at any time.

Equal Employment Opportunity Statement 
The Company and its affiliates, joint venture partners and entities under common management are Equal Opportunity Employers. They do not discriminate based on race, color, religion, national origin, age, sex, disability, veteran status, sexual orientation, gender identity, or any other protected 
status under federal, state, or local law. 

ADA Accommodation Statement 
Reasonable accommodations are available for qualified individuals with disabilities upon request. This role defines success by achieving essential function outcomes, not by the method of completion. 

Compliance Statement 
This job will be performed consistent with ADA, FMLA, FLSA, and other applicable federal, state, and local laws regulating employment.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

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