Provider Enrollment Specialist

TAG - The Aspen Group•East Syracuse, NY

1d•Remote

About The Position

The Provider Enrollment Specialist plays a vital role within our Payor Strategy team. This position is responsible for managing and maintaining the enrollment and credentialing for Aspen Dental providers with insurance payers and assigned dental plans. This role ensures timely and accurate submission of provider applications, updates and recredentialing to facilitate uninterrupted billing, reimbursement and patient care. The successful candidate will report to the Enrollment Manager.

Requirements

High school diploma or equivalent required
1- 3 years of experience in payor enrollment.
Working knowledge of commercial payors and government payor requirements.
Proficient in Microsoft office and credentialing software including but not limited to CAQH, Availity.
Strong attention to detail, organization and follow up skills.
Excellent communication and customer service abilities interacting with internal teammates and external clients.
Detail oriented, with strong level of analytical and problem-solving skills.

Nice To Haves

Associate or Bachelor’s degree preferred.
Experience in working with multi-specialty large group practices; dentistry is a plus.
Knowledge of revenue cycle and billing processes.
Familiarity with NPI and file provider management.

Responsibilities

Prepare, submit and track payer enrollment applications for new providers and existing provider changes.
Maintain accurate records of all enrollment activities in the credentialing system.
Communicate with insurance companies, healthcare providers and internal departments to ensure applications are processed efficiently.
Monitor enrollment status and follow up with payers to resolve delays or issues.
Update provider demographic and practice information with all contract payers as needed.
Ensure recredentialing timelines and requirements are maintained so providers enrollment status remains intact with no lapses.
Work closely with Field Support, Operations, Revenue Cycle Management (RCM) team to resolve any escalated enrollment or credentialing issues in a timely manner.
Research and resolve out of network claims issues by investigating provider participation status and effective dates of enrollment.
Coordinate temporary provider enrollments and ensure all necessary documentation, linkage and payer updates are completed.
Collaborate closely with RCM on status of provider enrollments including providing reports submission as needed.
Generate and maintain enrollment status reports.
Support audits, and other duties as assigned.