Provider Enrollment Specialist (Full-Time, M-F)
WASHINGTON REGIONAL MEDICAL CENTER•Fayetteville, AR
•Onsite
About The Position
This position serves in a crucial role in coordinating, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. This position facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, tracking, and monitoring. This position assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement.
Requirements
- Bachelor’s degree in healthcare administration or a minimum of 2 years of applicable experience in provider relations or healthcare administration.
- Competent in Microsoft Office
- Skill in organizational, interpersonal, and verbal/written communication skills.
Nice To Haves
- Previous experience in provider relations or healthcare administration preferred (required in lieu of degree).
Responsibilities
- Enroll each new provider into the selected health plans by submitting the required documentation to the designated payor contacts.
- Submit provider changes and terminations to all selected health plans to the designated payor contacts.
- Track provider loading completion for each payor and follow up on loading discrepancies or inaccuracies.
- Maintain accurate rosters for all health insurance payors and submit payor rosters at designated intervals or upon request of a specific payor.
- Track health insurance plan participation for all providers.
- Serve as point-of-contact for enrollment status inquiries.
- Notify provider designated representative of loading completion and the respective dates for each payor.
- Resolve any claims disputes resulting from provider enrollment and loading issues.
- Provide general administrative support to the PHO office and work closely with PHO staff.
- Assist with other duties, as assigned, including but not limited to credentialing and database management functions.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
