Provider Enrollment Specialist

• Process and maintain provider applications for enrollment and re-enrollment with Medicare, Medicaid, BCBS, and Commercial payors
• Prioritize and manage multiple enrollments in a deadline-driven environment
• Distribute, log, receive, and scan Provider Enrollment Packets
• Update National Provider Database information
• Monitor medical licenses and DEA credentials to ensure they are active and in good standing
• Serve as primary contact for providers and payors regarding enrollment and re-enrollment
• Identify provider eligibility issues for Government plans and advise management
• Procure required provider documents and escalate non-responses
• Enter application and enrollment documentation into provider databases
• Follow up on submissions via online, email, or phone to ensure timely approval
• Monitor Provider Enrollment AR on Hold reports and resolve issues
• Assist with roster maintenance and training with global partners
• Update databases for implementation changes
• Solve enrollment-related issues using critical and strategic thinking
• Maintain accurate database information and perform data quality cleanup
• Maintain confidentiality of privileged information
• Work in CAQH and update provider credentials every 90 days
• Occasionally be onsite at a client facility to distribute PEPs and facilitate in-person enrollment
• Document payor approvals and effective dates so information is pushed to the Billing System
• Monitor payor requirement changes and communicate them to management

Provider enrollment specialist managing healthcare payor credentialing for SCP Health

Provider Enrollment Specialist I

Provider Enrollment Specialist managing Medicare, Medicaid, and commercial payor enrollment for SCP Health, a clinical practice management company.
Maintaining provider credentials, applications, databases, and approvals.

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Provider Enrollment Specialist I