Provider Enrollment Specialist Job Description
Provider enrollment specialist
provides oversight for Data entry of enrollment and post enrollment information into required health plan systems daily.
Provider Enrollment Specialist Duties & Responsibilities
To write an effective provider enrollment specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included provider enrollment specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Serve as a liaison to regional offices troubleshooting any enrollment issues
Keep Billing Services and Systems Supervisor informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, to prevent delayed claims filing and cash flows
Accurately maintain all internal systems with appropriate provider and network participation information
Complete appropriate steps for updating and maintaining Provider Enrollment Databases and to ensure claims processed timely and accurately
May serve as a member of the Management Team or New Practice Acquisition Teams representing Provider Enrollment
Develops databases and spreadsheets for tracking organization providers
Assist other staff in the resolution of provider enrollment issues
Facilitation of state licensing, DEA registration, and liability insurance applications/renewals
Review applications for all new providers for assigned regional contracts
Follow-up and check status of applications with payors
Provider Enrollment Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Provider Enrollment Specialist
List any licenses or certifications required by the position: CPCS, NAMSS, NCQA, CAQH
Education for Provider Enrollment Specialist
Typically a job would require a certain level of education.
Employers hiring for the provider enrollment specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Associates, Education, Business, Healthcare, Health Care, General Education, Medical, Graduate, Communications, Business/Administration
Skills for Provider Enrollment Specialist
Desired skills for provider enrollment specialist include:
Systems
Tools used in the department
Workflow
Applicable regulations
Data base experience and other computer related skills
Data entry
Spreadsheets
Word processing
Billing processes
Enrollment
Desired experience for provider enrollment specialist includes:
Must possess a minimum of 6 months to 1 year general administrative experience, or equivalent college level education
Strong computer skills (Excel, Databases)
Medical office experience is a plus
Minimum of two years provider credentialing experience with technical knowledge of regulatory requirements for credentialing and privileging
Highly developed intra-personal and team-building skills
Other computer related skills
Provider Enrollment Specialist Examples
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Provider Enrollment Specialist Job Description
Job Description Example
Our growing company is hiring for a provider enrollment specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for provider enrollment specialist
- Track and follow-up to obtain provider numbers
- Build knowledge base for payor requirements and forms
- Develop working knowledge of payor policies for multiple states
- Participate in establishing new pediatric, anesthesia and pain management practices
- Obtain required credentialing paperwork from insurance companies
- Maintain organized and accurate files efficient and effective credentialing tracking system to ensure the credentialing is obtained from all physician and non-physician providers
- Coordinates delivering provider applications to appropriate health plans
- May require some travel to different site locations meet with new clients
- Submit applications to payers
- Follow-up and check status of applications with payers
Qualifications for provider enrollment specialist
- Maintain high levels of organization while being extremely focused on detail
- Be able to efficiently use necessary computer software applications (ie., Excel, Word, Outlook)
- Must be able to prioritize projects
- Must maintain composure and professionalism under circumstances that may become stressful
- Intra-personal and team-building skills
- Two (2) years of college required
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Provider Enrollment Specialist Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of provider enrollment specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider enrollment specialist
- Processes and reviews provider enrollment applications and Medicaid / Medicare enrollment applications that require signature by corporate officers or managers for the O&P department and POPS
- Researches practitioner enrollment processes, when needed, for enrollment to ensure applications are filled out accurately
- Works closely with O&P Contracting Manager and the external provider enrollment departments (insurance based) to discern specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations
- Develop working knowledge of payer policies for multiple states
- Establishes and maintains detailed provider relations application process (including sample applications), specific state requirements, with name, address, and phone number of the contact people at each intermediary for assigned areas
- Prepares reports and interacts with the A/R group and other components of the billing service to facilitate problem solving and communication
- Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, Identifies and resolves problems with primary source verification elements by interpreting, analyzing and researching data
- Act as liaison between SMB clinical providers, clinical practice plan staffers and healthcare plans and payors (predominantly but not exclusively managed care companies) in addressing a variety of issues relative to the status of those clinical providers as credentialed and enrolled with the plans and payors
- Gather, analyze and format data, information and documentation required by health care plans and payors to credential and enroll clinicians at Stony Brook Medicine as participating providers in their respective plan and payor products
- Establish and maintain clinical provider files, collect and organize necessary data, information and documents regarding licensure, professional status and associations, regulatory and legal activities, clinical activities, and related subject matter, and format and maintain such data and information in an electronic database
Qualifications for provider enrollment specialist
- Certified Provider Credentialing Specialist (CPCS) candidates strongly preferred
- Knowledge of CAQH, PECO, Champs, and Vistar strongly preferred
- Working knowledge of various Payor categories (PPO, DHMO, Indemnity, ) preferred
- Is able to work well with others and independently
- Processing provider applications to all health plans
- Carrying out Primary Source Verification
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Provider Enrollment Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for a provider enrollment specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider enrollment specialist
- Update and maintain data in appropriate Provider Enrollment systems while ensuring accuracy and data integrity
- Ensure provider participation with contracted payors by taking appropriate next actions to complete enrollment, such as completing applications, rosters, and notifications
- Work with payors and providers to ensure compliance with enrollment process
- Initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment and billing errors, utilizing proper customer service protocol
- Authorize enrollment or refer to investigators for further review analyze and identify trends and provides reports as necessary
- Routinely communicates with both CPG Revenue Cycle, CPG outside billing agents, Ark-La-TX Health Network, and CPG Managed Care Department to scan for billing and collection issues related to provider numbers
- Ensure all work is performed according to established policies and guidelines
- Maintain organized and accurate files efficient and effective credentialing tracking system to ensure credentialing is obtained from all physician and non-physician providers
- Keep PE Supervisor informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, to prevent delayed claims filing and cash flows
- Organized manner
Qualifications for provider enrollment specialist
- Interaction with representatives from health plans to answer inquiries, clarify requirements
- Contributing to team performance through collaboration on tasks, participation in H3W and other staff meetings, huddles, Informs leadership of work
- Ability to lift a minimum of 30 pounds and ability push/pull a minimum of 50 pounds, which includes the lifting, pushing and/or pulling of supplies and equipment
- Ability to communicate and negotiate effectively with customer and third party payers
- Solid skills to evaluate issues and identify solutions
- Responsible for administrative support duties for the department
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Provider Enrollment Specialist Job Description
Job Description Example
Our company is searching for experienced candidates for the position of provider enrollment specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for provider enrollment specialist
- Researches practitioner enrollment processes for multiple state enrollment to ensure applications are filled out accurately
- Work closely with Provider Enrollment Manager to resolve credentialing file issues
- Helps run basic and more complex reports following standard processes
- Verifies information on forms, vouchers or other accounting documents according to process guidelines
- May assist in the preparation and processing of bank reconciliations, journal entries to modify the general ledger, and preparation of trial balances
- Displays knowledge of all procedures and processes to train and audit work of others
- Handles questions and inquiries
- Communicate with Patients and Patients Representatives to resolve healthcare accounts while offering excellent customer service
- Credential new providers with contracted health care plans
- Monitor processing of credentialing for new providers until confirmed participation
Qualifications for provider enrollment specialist
- Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
- Minimum of two years of experience in a managed care role, centralized credentialing office or related health care environment, such as credentialing or file maintenance, preferred with experience in Word and Excel
- Knowledge of contract language interpretation and administration
- Knowledge of health plan and governmental payer credentialing, enrollment and requirements
- Knowledge of standards interpretation as related to NCQA
- Knowledge of federal and state insurance laws and their interpretation as appropriate
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Provider Enrollment Specialist Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of provider enrollment specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for provider enrollment specialist
- Analyzes various information systems EPIC, IDX Provider Edit reports and Provider Information Unit enrollment status reports
- Makes recommendations to management regarding billing enrollment administration and maintenance to improve effectiveness and efficiency of provider billing environment and re-enrollment
- Acts as liaison for Provider Enrollment Unit with other billing and/or clinical departments and with appropriate government agencies in support of group and provider enrollment and maintenance
- Interact professionally with leadership and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and or file maintenance transactions
- Creates and submits new group enrollment applications for newly opened or moving practices
- Enrolls new clinic and/or department groups to Electronic Data Information and Electronic Funds Transfer systems
- Continuous re-credentialing as required by each health care plan
- Update and re-attest information with CAQH (Council for Affordable Healthcare) quarterly for each provider enrolled
- Monitor credentialing/re-credentialing applications that have been forwarded to providers/office coordinators for timely return
- Experience with MS Office Excel required
Qualifications for provider enrollment specialist
- Familiarity with organizational structure physician offices in private practice
- Ability to work within a deadline-intense environment
- Knowledge of Microsoft Word and other PC applications
- Two years experience working in a health care business environment
- Medical Insurance and billing background
- Knowledge of the Medicare provider/facility application process