Provider Enrollment Specialist

Arkansas Children's Hospital•Little Rock, AR

7d•Hybrid

About The Position

The Provider Enrollment Specialist facilitates the applications from a new/existing provider’s through all stages in order to enroll or re-validate the provider’s with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas

Requirements

High school diploma or GED or equivalent
2 years of experience in lieu of a diploma/GED

Nice To Haves

Bachelor's degree in a related field of study.

Responsibilities

Conducts the enrollment process and maintains provider information in MD Staff platform
Adheres to deadlines and enrollment schedules by tracking files through all stages
Communicates with providers, payers, MSOs via email, phone, Teams and mail
Helps the department move to paperless by centralizing all provider data gathered in software
Maintains confidentiality and responsibility for all enrollment files through the process
Maintain an organized database of physician information, ensuring accuracy and completeness.
Ensure that all enrollment activities adhere to healthcare regulations and organizational policies.
Collaborate with internal departments, including HR, legal, and billing, to facilitate the enrollment process.
Address and resolve enrollment-related issues and discrepancies promptly. Monitor and meet goals established for KPI metrics
Generate reports and documentation related to physician enrollment, as needed. Maintaining work ques for provider enrollment within HIS system.
Other duties as assigned.