Provider Enrollment Specialist

Nemours Children's Health•Jacksonville, FL

About The Position

The Provider Enrollment Specialist works with Nemours internal and external stakeholders to complete enrollment and re-enrollment for the organization and its healthcare professionals. The role follows enrollment processes for managed care networks and government payors with which Nemours contracts or has agreements, supporting reimbursement for services. It involves ongoing communication with physicians, healthcare providers, administrators, support staff, and network representatives. The specialist communicates provider participation information through established processes to support patient scheduling and reimbursement. The position maintains enrollment records and internal systems, follows up with health plans to expedite approvals, and builds working relationships with providers, support staff, and network representatives. The specialist also collaborates with the team on workflows, processes, policies, and systems, cross-trains on plan requirements, and assists with priority projects and other duties assigned by a supervisor or department leadership. Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters annually across six states. It operates two freestanding children's hospitals, a network of more than 80 care practices, and more than 40 hospital partnerships. The nonprofit system is dedicated to children's health through clinical care, research, education, advocacy, and prevention, with a Whole Child Health approach. Nemours states that inclusion and belonging guide its strategy and growth, including commitments to culturally relevant care, reducing health disparities, and supporting associates, patients, and families.

Requirements

High school diploma required.
1–3 years of experience.

Nice To Haves

Associate degree preferred.

Responsibilities

Accurately complete enrollment and re-enrollment processes for appropriate healthcare providers according to each network or area’s requirements, department policies, network reimbursement requirements, and delegated contracts.
Maintain detailed electronic provider enrollment files, including electronically received and scanned documents, while following each enrollment stage and Nemours processes for protected health information (PHI).
Maintain accurate provider and network participation information in internal systems, including ECHO, Excel, PET Tracker, iGuide, Qliksense, the NPL tracker, internet, Outlook, and word-processing systems.
Follow up with health plans and their representatives to expedite participation approval.
Develop and maintain working relationships with Nemours providers and support staff to obtain timely information and facilitate enrollment and re-enrollment.
Develop and maintain relationships with network representatives to facilitate enrollment and re-enrollment and maintain accurate data in plan directories.
Send enrollment applications to providers as appropriate to obtain signatures and demographic information.
Collaborate with team members to create, evaluate, and maintain department workflows, processes, policies, and systems.
Cross-train on plan requirements to assist one or more team members with assigned duties.
Assist with special priority projects and other duties assigned by the employee’s supervisor or department leadership.