Provider Enrollment Specialist

Quest Diagnostics•West Norriton, PA

1d•Onsite

About The Position

The Provider Enrollment Specialist will manage, monitor, and complete activities related to Provider Enrollment applications, revalidation updates, and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) and Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers. This role will drive process compliance, controls, and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.

Requirements

3 + years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments.
Relevant experience in large, complex organizations, commercial labs, or healthcare organizations.
Strong analytical and problem-solving skills.
Strong interpersonal skills; ability to work with external clients and multiple levels internally.
Ability to handle confidential or sensitive information with discretion.
Strong written & verbal communication.
Strong attention to detail.
Strong technical skills in MS Word and Excel.
Able to multi-task and perform in a fast-paced environment.

Nice To Haves

Bachelor’s Degree

Responsibilities

Review, prepare, and submit requests for Medicare, Medicaid, and Health Plan payers to include completion of but not limited to: provider enrollment applications, revalidation requests, NPI enrollments, licensure updates, CAQH physician credentialing, health plan credentialing, attestations, and disclosures of ownership.
Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations, and Optum to successfully complete enrollment requests and related activities.
Engage with payers directly to discuss enrollment issues, inquiries, updates, and due dates of enrollment applications.
Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer-defined enrollment/re-enrollment deadlines.
Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process.
Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and the DocuSign eSignature tool.
Accurately and efficiently submit enrollment and credentialing applications.
Effectively manage and update the status of enrollments by way of case creation and management.
Effectively communicate with agencies, health plans, and internal stakeholders on the status of enrollments and credentialing applications.

Benefits

Day 1 Medical
supplemental health, dental & vision for FT employees who work 30+ hours
Best-in-class well-being programs
Annual, no-cost health assessment program
Blueprint for Wellness® healthyMINDS mental health program
Vacation and Health/Flex Time
6 Holidays plus 1 "MyDay" off
FinFit financial coaching and services
401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
Employee stock purchase plan
Life and disability insurance, plus buy-up option
Flexible Spending Accounts
Annual incentive plans
Matching gifts program
Education assistance through MyQuest for Education
Career advancement opportunities