Provider Enrollment Specialist

Pediatrix Medical Group • Richmond, VA

73d

About The Position

We have a Provider Enrollment Specialist career opportunity for an experienced professional to join our team at Pediatrix Medical Group. We are a national organization, and one of the nation's largest providers of prenatal, neonatal and pediatric services. Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere. We are confident that you'll love being a part of the Pediatrix team.

Requirements

• Associate's degree (A. A.) or equivalent from two-year college or technical school.
• Three (3) or more years related experience or equivalent combination of education and experience.
• Knowledgeable with Group Entity health plan enrollments, state regulations and appeal processes.
• Knowledgeable in Provider Enrollment policies and procedures.
• Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Ability to effectively present information to top management, public groups, and/or boards of directors.
• Ability to work with mathematical concepts such as probability and statistical inference.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form.
• Ability to understand medical terminology and protocols.

Nice To Haves

• Experience in Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue (Entity database software).
• Experience with CAQH, and Credentialing/Provider Enrollment Tracking Software (IntelliCred).

Responsibilities

• Timely and effectively enroll practitioners in health plans.
• Monitor progress, ensure timeliness of enrollment completion, and provide updates to the appropriate RCM central business offices.
• Assist Management in maintaining provider enrollment goals for all divisions.
• Validate up-to-date plan enrollment forms, complete applications, submit them to plans and follow up until enrollment is complete.
• Verify accuracy and coordinate entry of new and revised provider information into IntelliCred and Master Database.
• Map forms in IntelliCred and prioritize work, reviewing and researching Health Plan Enrollment requirements at Corporate Business Office.
• Document assignments in the Credentialing/Provider Enrollment tracking system per the department's standard operating procedures.
• Contact health plans to determine enrollment requirements periodically and verify health plan requirements based on the specialty.
• Prepare/review group applications based on information provided during acquisitions, Tax ID mergers, and Organic Growth Initiatives (OGI).
• Communicate with Business Development, Business Integration and Credentialing to acquire prospective new provider group's required documents and/or signatures as needed.
• Maintain provider's profile in PE Tracking system (IC) with up to date information on active or pending providers.
• Maintain provider's profile in CAQH with up to date information on active or pending providers.
• Monitor all assigned delegated agreement health plan enrollments reports to ensure enrollments are being processed timely.
• Validate status of onboarding provider's enrollments to ensure Target Start Date is met.
• Perform other job-related duties within the job scope as requested by Provider Enrollment Management.

Benefits

• Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs.
• 401k plan and Employee Stock Purchase Program.
• Some benefits are provided at no cost, while others require a cost share between employees and the company.
• Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees