Provider Enrollment Specialist

The Nemours Foundation•Jacksonville, FL

About The Position

The Provider Enrollment Specialist interacts with Nemours stakeholders to enroll and re-enroll the organization and its healthcare professionals with managed care networks and government payors. The role follows enrollment processes for contracted networks and payors to support reimbursement for services. It maintains provider participation information and communicates it to internal and external customers, including physicians, healthcare providers, administrators, support staff, and network representatives, to support patient scheduling and reimbursement.

Requirements

High school diploma required.
1–3 years of experience.

Nice To Haves

Associate degree preferred.

Responsibilities

Accurately complete enrollment and re-enrollment processes for appropriate healthcare providers according to network requirements, department policies, reimbursement arrangements, and delegated contracts.
Maintain detailed electronic provider enrollment files, including received and scanned documents, while following each process stage and Nemours’ PHI procedures.
Maintain accurate provider and network participation information in internal systems.
Follow up with health plans and their representatives to expedite participation approvals.
Build and maintain relationships with Nemours providers and support staff to obtain timely information and facilitate enrollment and re-enrollment.
Build and maintain relationships with network representatives to facilitate enrollment processes and keep plan directory data accurate.
Send enrollment applications to providers as needed to obtain signatures and demographic information.
Collaborate with team members to create, evaluate, and maintain department workflows, processes, policies, and systems.
Cross-train on plan requirements to assist other team members with assigned duties.
Assist with special priority projects and other duties assigned by the supervisor or department leadership.