Provider Enrollment Specialist

Amerihealth Caritas•,

3d•Remote

About The Position

The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. This role also executes the panel transfer process, completes assigned projects, and interacts with internal and external clients regarding provider maintenance activities.

Requirements

Associate’s degree or equivalent work experience.
Minimum of 1 year of related healthcare experience.
Proficiency in Microsoft Office applications, including Word, Excel, Access, and Outlook.
Ability to communicate effectively with providers, members, and internal teams.
Problem‑solving and analytical skills for resolving provider-related issues.

Nice To Haves

Claims processing experience preferred.
Knowledge of provider types and healthcare claims processes preferred.
Experience with Facets software preferred.
Strong attention to detail and organizational skills.

Responsibilities

Communicate provider changes to appropriate providers, members, and internal departments within required timeframes.
Coordinate provider mailings for all claims in the invalid provider queue that cannot be processed due to missing or invalid information.
Research and resolve returned checks and provider mail.
Assist providers and internal customers by responding to and resolving all inquiries related to Panel Transfers, Panel Releases, and Special Needs PCP assignment processes.
Complete department reports, logs, and documentation as assigned.
Ensure all work is completed in accordance with service level agreements (SLAs).
Attend required annual training sessions and maintain compliance with organizational standards.