Provider Enrollment Specialist
3 months ago
Job Summary:
The Provider Enrollment Specialist is responsible for coordinating and managing the enrollment of healthcare providers into various insurance networks, including Medicare, Medicaid, and private insurance plans. This position plays a crucial role in ensuring that providers are properly credentialed, enrolled, and maintained within payer systems, enabling smooth claims processing and reimbursement. The specialist will work within the revenue cycle management department, focusing on post-acute care providers.
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.
Qualifications:
- 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.
Preferred Qualifications:
- Experience working with Medicaid, Medicare and commercial insurance networks.
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