Provider Health Plan Enrollment Specialist

Camarena Health•Madera, CA

3d•$24 - $26

About The Position

Under the general supervision of the Billing Manager, the Provider Health Plan Enrollment Specialist processes and manages enrollment of healthcare providers with insurance networks and government programs. The role ensures provider enrollment and credentialing information is accurate, current, and compliant with regulatory and organizational requirements. It involves managing provider data, coordinating applications and enrollment documentation, maintaining records, supporting providers and internal departments, and helping improve enrollment processes. The position also includes clerical and data-entry support, participation in required meetings, confidentiality, and other duties assigned by management.

Requirements

High school diploma or equivalent.
Two to four years of provider health plan enrollment and credentialing experience in a healthcare setting.
Strong understanding of healthcare regulations, insurance plans, and credentialing processes.
Strong organizational and time-management skills.
Proficiency with credentialing software and Microsoft Office Suite.
Excellent communication and interpersonal skills.
Team-oriented approach and leadership skills.
Ability to provide work direction to assigned billing personnel and thorough knowledge of relevant systems and procedures.
Ability to foster collaboration, teamwork, and mutual respect.
Ability to work independently and perform critical work under deadlines.
Ability to communicate effectively with supervisors and other staff.
Ability to move up to 20 pounds and push up to 50 pounds on wheels.
Ability to hear staff by phone and people served in person, and to speak clearly to communicate with clients and staff.
Adequate vision to read memos, computer screens, personnel forms, and clinical and administrative documents.
High manual dexterity and ability to reach above shoulder level, bend, squat, sit, stand, stoop, crouch, reach, kneel, twist or turn, finger, and feel.

Nice To Haves

Multi-specialty healthcare experience.
Ability to work collaboratively in a fast-paced environment.
Familiarity with medical practice management systems; Athenahealth is a plus.
Experience with MedTrainer credentialing software.

Responsibilities

Manage enrollment for current and new healthcare providers, including gathering documentation and completing applications for insurance networks and government programs such as Medicare and Medicaid.
Review and maintain accurate, current provider information in enrollment databases for billing and credentialing purposes.
Conduct credentialing and recredentialing processes for healthcare providers.
Facilitate provider enrollment in health plans by completing and submitting required documentation.
Track enrollment statuses and ensure applications are processed in a timely manner.
Use credentialing software and databases to manage provider information.
Audit provider files and databases for accuracy and completeness.
Serve as the primary contact for providers regarding health plan enrollment and related inquiries.
Collaborate with internal teams, including Billing and Human Resources, to streamline processes.
Stay current on health plan enrollment regulations and credentialing standards.
Assist with preparation of documentation for audits and regulatory reviews.
Provide guidance and training to new staff on credentialing processes and systems.
Help providers navigate enrollment challenges and requirements.
Identify opportunities to streamline enrollment and implement efficiency best practices.
Attend and participate in required team, department, program, and employee meetings and activities.
Provide clerical and data-entry support for unit operations and support other departments as needed.
Work flexible or extended hours when necessary.
Maintain confidentiality of provider information and follow Camarena Health confidentiality rules.
Perform other work-related duties as assigned.