Provider Enrollment Specialist

St. Luke’s University Health Network•Allentown, PA

About The Position

The Provider Enrollment Specialist ensures that initial and re-credentialing applications for St. Luke’s University Health Network (SLUHN) employed providers are submitted to identified third-party and government health insurance carriers. The role also maintains membership and renewal information for professional and DEA licenses, board certification, and professional organization memberships.

Requirements

High school education.
Experience with personal computers and the Microsoft Office suite of products.
Strong customer service skills.
Excellent verbal and written communication skills.
Detail-oriented and service-oriented.

Responsibilities

Prepare provider enrollment applications and written link letters for submission to payers.
Ensure providers and groups are revalidated with payers on time by completing re-credentialing applications with current provider information and signatures.
Make and receive calls from providers and practice managers to resolve payer issues and verify participating status.
Update and maintain the database with enrollment tracking, effective dates, provider numbers, and correct provider demographics.
Scan and file paperwork and documents in a shared folder for tracking and proof of submission to payers.
Apply for New Jersey licensure for identified providers.
Create new group enrollment applications for newly opened or moving practices.
Respond promptly to inquiries from SLUHN departments and help resolve enrollment-related issues.
Ensure the SLUHN billing department receives resolution on enrollment issues that assist with claim processing.
Identify and communicate current or potential enrollment issues that could result in lost revenue or patient dissatisfaction.
Participate in team meetings and conference calls with payers.
Complete online Doing Business As (DBA) applications for new or renamed groups.
Create check requests for out-of-state enrollment fees.