Provider Onboarding and Enrollment Specialist
About The Position
The Provider Onboarding and Enrollment Specialist is responsible for ensuring healthcare professionals are compliant with licensing/certifications and meet necessary requirements for healthcare payer participation. The Provider Onboarding and Enrollment Specialist is responsible for collecting all required provider onboarding and enrollment information and documents for a timely submission to the credentialing and facility privileging teams. This specialist reviews claim denials related to healthcare payer enrollment/credentialing and contracting to increase revenue for their assigned providers.
Requirements
- 1+ years of experience in healthcare billing, credentialing, or provider enrollment
- Experience with NPPES, CAQH, and payer portals
- Compliance awareness: HIPAA, CMS guidelines, billing, reimbursement, and state specific healthcare regulations.
- Familiarity of group and provider Medicare and Medicaid credentialing and billing.
- Strong written and oral communication skills
- Excellent organizational and time management abilities
- Ability to manage multiple tasks and track deadlines
- Proficiency in Microsoft Office (Word, Excel, Outlook)
Responsibilities
- Develop and maintain relationships with providers and clinical leadership to ensure provider onboarding and enrollment/credentialing items are received timely. This includes serving as a primary point of contact for enrollment/credentialing related inquiries.
- Collect, review, verify, submit, and follow up on required provider credentialing documents, including by not limited to, Identification, Signature Logs, CAQH Information, Disclosure Questions, State Licenses, Certifications, NPDB Self Query, W9, Supervising Collaborative Agreement, etc.
- Collaborate with various teams including recruitment on new hire details, third party vendor on credentialing processes and requirements, and clinical leadership to facilitate a seamless onboarding and credentialing process.
- Maintain provider enrollment software (Modio); including but not limited to, data entry, data review, data clean up, and document management.
- Maintain PHP Provider Roster (active, new hire, and termed providers).
- Maintain New Vista Provider Roster (active, new hire, and termed providers).
- Complete, submit, and track West Virginia Senior Advantage/CommuniCare Advantage (WVSA/CCA) Provider Enrollment applications.
- Apply, renew, and maintain Certificates of Insurance (Malpractice) for PHP and New Vista providers.
- Prepare, provide, and track PHP Provider Licensing and Certification Expiration Reports for clinical leadership and providers; includes follow-up with providers and collection of renewed licenses and certifications.
- Identify opportunities in the provider onboarding and enrollment processes to improve efficiency and accuracy; includes collaboration with peers and leadership to develop process procedures and policies.
- Unite with leadership and the Billing Team to identify and reduce credentialing related claim denials.
- Execute various Provider Onboarding and Enrollment related projects and training as assigned.
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
