Provider Enrollment Specialist (Full-Time, M-F)

Washington Regional Medical System • Fayetteville, AR

1d • Onsite

About The Position

The Provider Enrollment Specialist reports directly to the Health Partners Provider Enrollment Manager. 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level