T3Cogno

General

• Responsible for coordinating requests for participation in health insurance network as a medical provider
• Monitoring and maintaining provider enrollment and re-enrollment process in a timely and compliant manner
• Reviewing provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements
• Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner
• Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others
• Maintains positive working relationships with providers
• Plays an active role in explaining providers and practice/office managers the submission requirements for credentialing/recredentialing processes
• Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
• Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data
• Proactively obtains updated provider credentialing data prior to expiration
• Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
• Completes all additions, updates, and deletions
• Supports new provider onboarding processes as related to enrollment
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner
• Fosters working relationships and teamwork with departments, vendors, etc.
• Develops databases and spreadsheets for tracking organization providers
• Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management
• Continuously searches for process improvements to achieve accuracy and efficiencies
• Performs other duties as assigned or required

Provider Enrollment Specialist