Provider Enrollment Specialist

Job Description

• Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner • Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified • Maintains positive working relationships with providers • Plays an active role in explaining providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes • Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc • Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data • Proactively obtains updated provider credentialing data prior to expiration • Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions • Completes all additions, updates, and deletions • Supports new provider onboarding processes as related to enrollment • Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc • Develops databases and spreadsheets for tracking organization providers • Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management • Continuously searches for process improvements to achieve accuracy and efficiencies • Performs other duties as assigned or required

Qualifications

• High School Diploma or equivalent • Experience in Radiology Payer Enrollment • 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements • Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools • Motivated to quickly learn and demonstrate strong problem-solving skills • Strong project management and multitasking skills • Excellent interpersonal and communication skills • Strong writing skills and attention to detail • Strong organizational skills and ability to be attentive to details • Demonstrated knowledge of healthcare contracts preferred

Benefits

• Access to a 401(k) Retirement Savings Plan • Comprehensive Medical, Dental, and Vision Coverage • Paid Time Off • Paid Holidays • Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services