Provider Enrollment Specialist - Remote US
About The Position
Provider Enrollment Specialists work as the enrollment liaison between Gainwell Technologies, Idaho Department of Health & Welfare (Medicaid Division) and the Idaho Medicaid provider community (direct physicians, groups, organization administrators, compliance officers, billers, and credentialing staff). This position is responsible to educate, support and validate achievement of outlined enrollment requirements and process initial and maintenance applications. Requirements of this role include delivering the highest quality end-to-end service and support, by concise communications, through analysis and adherence to timely response deliverables. Specialists provide, build, maintain, and promote positive relationships through a vast array of consistent engagements with key stakeholders.
Requirements
- 3+ years’ experience working in healthcare industry preferably credentialling or regulatory.
- Strong Microsoft Office skills and experience working with business solutions software.
- Proven experience with issue resolution focused on research, provider enrollment, requirement compliance and customer service highly preferred.
- Ability to investigate complex inquiries while leveraging requirements to promote successful outcomes.
- Strong written and verbal communication skills.
- Strong computer and business solutions software skills.
- Proficient knowledge of Microsoft Office.
- Strong organization and time management skills
Responsibilities
- Review and process initial provider enrollment applications per State requirements
- Updates provider changes, certifications, and license updates
- Navigates multiple systems, licensing and medical certification websites to obtain updates
- Follows up with providers on outstanding issues within contractual guidelines
- Provides excellent customer service with professional verbal and written abilities while meeting documented quality standards
- Utilize claims systems, reporting tools, and operational documentation to review pharmacy claims, validate reimbursement logic, and support claims accuracy and process improvement initiatives.
- Investigate complex inquiries, communicate findings and resolutions to internal and external stakeholders via secure messaging, email, or verbal communication, and document all activity within designated system tools.
- Work both independently and collaboratively with cross-functional teams while supporting operational goals and performance expectations.
Benefits
- medical
- dental
- vision
- 401(k)
- paid time off
- employee wellness and support programs
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
