Provider Enrollment Specialist

University Physicians' Association•Knoxville, TN

2h•Hybrid

About The Position

If you’re looking to build a rewarding career in healthcare within a supportive, growth-focused culture, University Physicians’ Association (UPA) would love to have you join our team. We are committed to creating a positive workplace where team members can learn, grow, and succeed—while enjoying a comprehensive and competitive benefits package. This position offers the opportunity to work remotely following a required 90-day on-site training period in Knoxville, TN. Candidates must be able to commute to Knoxville during training.

Requirements

High School Diploma or GED required
Minimum of two (2) years of experience in a healthcare delivery environment or one (1) to two (2) years of credentialing/enrollment experience
Strong verbal and written communication skills
Proficiency in Excel
Excellent organizational skills with a high level of accuracy and attention to detail
Ability to maintain professionalism and confidentiality
Working knowledge of CMS, NCQA, and state and federal credentialing regulations
Ability to multitask and manage complex responsibilities
Flexible, collaborative, and team-oriented approach
Self-motivated and able to work independently with minimal supervision
Proficiency in Word processing and database systems
Ability to work effectively with diverse individuals and under varying circumstances
Commitment to the values and mission of UPA and the Managed Care Department

Nice To Haves

experience with Cactus preferred

Responsibilities

Serve as a liaison between UPA clients and insurance carriers to ensure accurate provider enrollment and resolve large-scale issues
Track and follow up on provider enrollment applications submitted to payers
Communicate with payers regarding application status and document updates in the credentialing/enrollment database
Maintain accurate provider data within UPA’s credentialing software and ensure timely updates with insurance carriers
Perform quarterly provider data verifications for all UPA clients and as required by individual carriers
Notify providers of upcoming license or malpractice insurance expirations
Coordinate provider terminations with UPA providers and the Medical Staff Office as needed
Participate in payer-delegated credentialing audits in accordance with NCQA requirements
Attend and actively participate in staff meetings and quality audits
Assist with the development and implementation of departmental policies, procedures, and forms
Perform other duties as assigned