Provider Enrollment Specialist (Full Time, Remote, North Carolina Based)

Alliance Health•Durham, NC

5h•$23 - $30•Remote

About The Position

The Provider Enrollment Specialist ensures that all providers in the Alliance Health Network are enrolled in NCTracks with an active Medicaid Health Plan and a valid taxonomy for the service requested. This role reviews the Provider Action Database to identify any providers for exclusion from the network. Specialists will only approve applications for services identified as a network need and/or services mandated by compliance with Parity. This position allows the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Requirements

High school diploma/GED and six (6) years of experience in an administrative support role in healthcare
Bachelor’s degree from an accredited College or University and two (2) years of experience in an administrative support role in healthcare
Knowledge of the organization and it’s functions
Knowledge of NCTracks system
Knowledge of computerized record-keeping techniques
Knowledge of and experience with records, reports and file maintenance
Proficient with Microsoft Office suite
Proficient with grammar, spelling, punctuation and vocabulary
Skilled at organizing work to meet schedules and timelines
Ability to communicate effectively both in oral and written form
Ability to understand and follow oral and written directions
Ability to exercise tact and discretion in working with confidential or sensitive information
Ability to work independently with little direction
Ability to establish and maintain effective working relationships with others
Ability to analyze situations accurately and adopt an effective course of action

Nice To Haves

Behavioral Health experience preferred
Experience with NCTracks preferred
Two years experience in provider enrollment preferred

Responsibilities

Review, Respond, and Process all Provider Application Requests and Notice of Change Requests
Monitor and respond to provider inquiries received via the Enrollment email Inbox and phone queue
Review NC Tracks to confirm the following: NPI enrollment, Site enrollment, Approved Taxonomy for service requested, Valid Health Plan enrollment
Review Alliance Health Provider Action Database for provider exclusions
Notify Contracts of approved additions and/or needed changes to contract
Complete written notice to providers regarding enrollment and contracting decisions per procedures
Meet all identified turn around times for provider enrollment responses
Verify that all NC Tracks information is reflected accurately in the ACS system based on the Provider Enrollment file
Ensure that all departments that are affected by any enrollment changes are notified timely and according to policy and procedure
Track Provider Applications Requests and Notices of Change
Track all provider requests and outcomes per department procedure