Provider Enrollment Specialist

• Process and maintain provider applications for enrollment and re-enrollment for 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 and maintain provider credentials
• Monitor medical licenses and DEA credentials to ensure they remain active and in good standing
• Serve as the 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-responsive providers
• Enter applications 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 the CAQH database 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 managers

Provider enrollment specialist managing healthcare payor credentialing for SCP Health

Provider enrollment specialist managing Medicare, Medicaid, and commercial payor credentialing for SCP Health.
Maintaining provider credentials, applications, databases, and enrollment approvals.

• 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 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.

• Manage provider enrollment processes with various insurance payers
• Review daily email communications for application approvals, requests, and status updates
• Track and update enrollment statuses using spreadsheets and internal systems
• Submit requests and complete enrollment-related actions once provider authorization is obtained
• Contact providers to obtain missing information or required documentation
• Follow up on submitted applications approximately every 15 days
• Maintain accurate records and documentation of enrollment activities
• Handle a high volume of requests, typically between 20 and 70 requests per day
• Use templated email responses while maintaining professional communication
• Follow established outreach and follow-up processes
• Verify requests are appropriate and complete before processing
• Assist with standard enrollments and more complex new provider enrollment cases

Provider enrollment specialist managing healthcare payer applications for BetterHelp

Provider enrollment specialist managing healthcare payer applications for BetterHelp.
Tracking statuses, documentation, and provider communications in a fully remote contract role.

• Support provider enrollment, maintenance, and renewal activities for the WV Medicaid program
• Review and process Medicaid provider enrollment applications, renewals, and maintenance requests
• Follow WV Medicaid-approved guidelines, the ACA, federal requirements, and established procedures
• Conduct extensive independent research
• Participate in special projects with occasional onsite requirements

Provider Enrollment Specialist supporting West Virginia Medicaid enrollment at Gainwell Technologies

Provider Enrollment Specialist supporting West Virginia Medicaid enrollment, renewals, and maintenance at Gainwell Technologies.
Processing provider applications under ACA, federal, and WV Medicaid requirements in a remote role with occasional onsite projects.

• Support clients through administering the provider enrollment and credentialing applications process.
• Responsible for preparing and submitting credentialing applications and supporting documentation for enrolling individual physicians and physician groups with payers.
• Provide advisory services for organizational level NPI management and provider enrollment challenges.
• Ensure the provider onboarding process relating to credentialing and enrollment is a seamless and expedited experience.

Provider Enrollment/Credentialing Specialist supporting healthcare consulting firm

Provider Enrollment/Credentialing Specialist

Provider Enrollment/Credentialing Specialist supporting healthcare consulting firm in the U.S. Managing provider enrollment and credentialing applications for clients across the country.

• Credentialing new and established health care providers
• Maintenance of information including application completion, follow up, data collection, data entry, and document review
• Establish and maintain data entry in CAQH
• Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner
• Verify provider and group information with insurance companies
• Coordinate information for enrollment and terminations of all providers
• Maintain good rapport and professional communication with Health Plan Representatives
• Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states
• Build strong working relationships with medical facilities and provider offices
• Adhere to department policies and procedures including timely delivery of completed work and use of resources
• Responsible for entering, updating, maintaining NPI and any other applicable provider numbers
• Provide concise, timely communication to appropriate leadership regarding potential credentialing issues
• Proactively share knowledge with colleagues
• Perform analysis and appropriate follow-up of each initial application and reappointment
• Work with physicians, professional staff and physician's office staff to acquire necessary materials and information

Credentialing Specialist managing healthcare provider information and documentation

Provider Enrollment, Credentialing Specialist

Credentialing Specialist responsible for managing healthcare provider credentialing and enrollment processing. Ensures accuracy and compliance in documentation for providers working with Medicare, Medicaid, and commercial insurances.

• Conduct complex, specialized duties to track, enter and review correspondence from medical stakeholders, partners and the public.
• Review rejected claims from medical providers and Medicare crossover rejections.
• Respond to inquiries from providers requesting information/application on becoming a provider in the Illinois Medical Assistance Program.

Provider Enrollment Specialist for the Illinois Department of Healthcare and Family Services

Provider Enrollment Specialist – Office Specialist, UMP

Provider Enrollment Specialist conducting complex duties to track and review medical correspondence. Joining the Illinois Department of Healthcare and Family Services to assist providers with application processes.

• Under minimal supervision coordinates, monitors and maintains Medicare, Medicaid and Dental Plans enrollments for the Medical Staff and Advanced Practice Providers
• Ensures compliance with the accrediting and regulatory agencies (i.e., TJC, NCQA, and CMS) in regards to credentialing while developing and maintaining a working knowledge of the statues and laws
• Coordinates and facilitates the enrollment of professional providers with various payers for professional services and governmental reimbursement through Medicare and Medicaid
• Reviews provider credentialing and/or recredentialling/revalidation data for accuracy based on licensing requirements and various insurer and government payer requirements
• Completes timely application processes based on payer and government specific formats
• Continually follows up on enrollment and/or recredentialling/revalidations statuses until complete
• Maintains systems/applications used in the enrollment processes
• Completes provider payer enrollment/credentialling and recredentialing with all identified payers in a timely manner
• Handles highly sensitive and confidential information regarding professional providers
• Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified
• Maintains positive working relationships with providers
• Plays an active role in explaining and informing providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes
• Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc
• Identified and resolved 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 related to enrollment
• Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes
• Proactively communicated any changes regarding contracting as it relates to enrollment and operations
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering 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

Provider Enrollment Specialist ensuring compliance with Medicare and Medicaid enrollments

Provider Enrollment Specialist coordinating Medicare and Medicaid enrollments for medical staff at Denver Health. Ensuring compliance with regulatory agencies and maintaining relations with providers.

• Review and process initial provider enrollment applications per State requirements
• Updates provider changes, certifications, and license updates
• Navigates multiple systems, licensing and medical certification websites to obtain updates
• Follows up with providers on outstanding issues within contractual guidelines
• Provides excellent customer service with professional verbal and written abilities while meeting documented quality standards

Provider Enrollment Specialist handling applications for Idaho Medicaid provider community

Provider Enrollment Specialist processing initial applications for Idaho Medicaid providers. Working remotely to support provider enrollment and maintain relationships with key stakeholders.

• Manage initial credentialing and payer enrollment for new clinicians across commercial, Medicare, and Medicaid managed care plans
• Maintain CAQH profiles, NPPES/NPI records, PECOS enrollments, payer applications, and revalidations
• Track licenses, malpractice coverage, certifications, effective dates, and expirations
• Maintain accurate payer rosters and group/individual linkages across our office locations
• Follow up persistently with payers on pending applications, missing items, effective dates, and enrollment discrepancies
• Coordinate with billing so claims are not submitted before payer effective dates
• Keep clean, auditable records of every application, effective date, payer communication, and follow-up step
• Improve the credentialing tracker and written process as the practice grows

Credentialing Specialist handling payer enrollment for behavioral health clinicians

Credentialing Specialist / Provider Enrollment Specialist

Credentialing Specialist managing payer enrollment and credentialing for a behavioral health group practice. Ensuring timely enrollment for clinicians while maintaining compliance and clean records.

• Works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials.
• Researches, resolves, and enrolls any payer issues, utilizing a variety of proprietary and external tools.
• Contacts clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website.
• Performs follow-up with market locations to research and resolve payer enrollment issues.
• Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications.
• Maintains documentation and reporting regarding payer enrollments in process.
• Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team.

Provider Enrollment Specialist handling payer enrollment issues at Ventra Health

Provider Enrollment Specialist resolving payer enrollment issues for Ventra Health. Collaborating with clients and government services to ensure provider enrollments.

Provider Enrollment Specialist jobs in United States

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