Provider Enrollment Specialist

The Enrollment Coordinator provides overall support to the Director of Payor Contracting, as related to Provider enrollment, and other administrative tasks as assigned, while working closely with other departments including the Revenue Cycle team and Physician Credentialing.

Essential Functions & Responsibilities:

• Perform the administrative and enrollment duties necessary to complete the provider enrollment process for Insurance purposes.
• Work directly with administrative contacts and departments which include: performing regular updates and communicating clearly on the status of the enrollment process to all departments and offices who require frequent updates.
• Provide superior customer service at all times to internal and external contacts including office managers, providers, payer representatives, and other staff members.
• Help with managing the onboarding process by working directly with providers to help facilitate the process of enrollment with insurance payers.
• Manage the enrollment/credentialing process from start to finish including obtaining applications from the payers, completing applications accurately, submitting applications timely per policy or within a reasonable time frame to avoid delays.
• Complete regular follow up with the payers to ensure applications are being processed, and obtaining confirmation once the credentialing process is completed.
• Updating direct report on all completed applications.
• Act as liaison between practitioners and payers, identifying delays with payers, escalate and communicate delays or issues timely to management.
• Properly maintain files on each provider as required by the department, items may include (CAQH upkeep, CV, certifications, licenses, COIs etc.). Maintain accurate and proper updates in the credentialing database (Modio) for tracking license, certification, and professional liability expirations to ensure timely renewals.
• Work closely with the other team members to ensure that the enrollment is handled as quickly and professionally as possible.
• Maintain knowledge of requirements for credentialing providers with contracted health plans.
• Provide consistent upkeep of provider enrollment status throughout the enrollment cycle and documenting each step of the process in the provider database (Modio).
• Audit and update health plan directories for current and accurate agency and provider information, as well as primary contacts.
• Generate and maintain weekly and monthly reports of credentialing and enrollment processes.
• Responds to staff, provider, payer and other stakeholder inquiries and requests in a timely manner.

Skills & Abilities:

• 
  Extremely organized and flexible with the ability to simultaneously handle the enrollment and credentialing functions of the department.
• Sound work ethics with the ability to make independent decisions, be detail oriented with excellent written and verbal communication skills.
• Ability to interact with staff in a fast-paced environment, sometimes under pressure, remaining flexible, proactive, resourceful and efficient.
• Ability to exhibit a high level of professionalism and confidentiality.
• Excellent customer service skills and positive demeanor.

Qualifications & Experience Required:

• Must have knowledge of healthcare credentialing, licensure, certification and hiring requirements.
• Microsoft Office experience, specifically Excel.
• Modio experience is a plus.
• Experience working with health insurance, including CMS is a plus.
• 2-3 years of experience specifically related to Provider enrollment.