Provider Enrollment Specialist
About The Position
Coordinates and facilitates enrollment of Allegheny Clinic professional providers with payers for professional services reimbursement. Reviews provider credentialing and recredentialing data for accuracy against licensing and insurer requirements, obtains information from providers and other sources, completes payer-specific applications, follows up on enrollment status through completion, resolves issues, and maintains systems and applications used in the enrollment process. The role also supports provider onboarding, communicates changing requirements, maintains provider tracking data, and seeks process improvements. The position handles sensitive provider information and collaborates with physicians, office staff, management, contracting, insurers, and other partners. Employees must follow the company’s ethical and legal standards, Code of Business Conduct, HIPAA privacy requirements, and information security policies when handling confidential or covered information.
Requirements
- At least 2 years of experience in a physician medical practice with a basic understanding of payer billing requirements and claims processing, or experience with payer credentialing and enrollment requirements.
- Advanced computer skills using Word, Excel, Adobe, and web-based applications.
- Excellent customer service, follow-up, and communication skills.
Nice To Haves
- Associate’s degree.
- Certified Provider Credentialing Support (CPCS) certification from the National Association Medical Staff Services.
- Experience with ECHO and/or professional provider credentialing.
- Delegated credentialing experience.
- Experience with Cactus and/or other professional provider credentialing software.
Responsibilities
- Complete provider payer enrollment, credentialing, and recredentialing with identified payers in a timely manner while handling sensitive and confidential provider information.
- Resolve enrollment issues by collaborating with physicians, non-physicians, office staff, management, contracting, insurers, and others; maintain positive provider relationships and explain submission requirements and compliance expectations.
- Obtain updated provider information from provider offices, state licensing boards, malpractice insurance companies, residency training programs, and other sources.
- Identify and resolve problems with primary source verification by interpreting, analyzing, and researching data.
- Proactively obtain updated credentialing data before expiration; create, develop, and maintain applicable matrices or use departmental software; complete additions, updates, and deletions; and support onboarding as it relates to enrollment.
- Update practice management staff and others about changes to provider credentialing requirements and communicate contracting changes affecting enrollment and operations.
- Communicate updated payer enrollment information, including payer provider numbers, to practice operations in a timely manner and foster teamwork with departments and vendors.
- Develop databases and spreadsheets to track organizational providers and ensure data is accessible and transparent for executive inquiries and other management needs.
- Continuously seek process improvements to achieve accuracy and efficiency.
- Perform other duties as assigned or required.
- Comply with the Code of Business Conduct, applicable laws and regulations, company policies and training requirements, HIPAA privacy policies, and information security guidelines.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
