Provider Enrollment Specialist

A5 Healthcare one of one of the fastest-growing Credentialing Verification Organizations in the country is seeking a Provider Enrollment Specialist who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. This individual will have a direct impact on our firm’s mission of serving as a catalyst for those striving to achieve their highest potential. 

The Provider Enrollment Specialist ensures seamless plan enrollment (initial and renewal) of healthcare providers by adhering to NCQA, URAC, and CMS accreditation standards. This role involves processing initial applications, renewals, revalidations, rosters, and maintenance of provider data, ensuring all provider information is accurate and up to date. The Specialist performs detailed data entry, conducts follow-ups on incomplete information, and maintains comprehensive records in a credentialing database, while effectively communicating with providers, internal staff, and external entities to resolve any issues related to enrollment and credentialing.

 

What You’ll Do:  

• Process and submit initial provider applications, revalidations, and renewal applications in compliance with NCQA, URAC, and CMS accreditation standards.
• Perform thorough and accurate data entry and verification of provider information into credentialing databases.
• Conduct timely follow-up on missing or incomplete information with the provider, client, or team lead responsible for a provider file to ensure prompt and efficient provider enrollment.
• Assist in the preparation and submission of required documentation for provider enrollment and credentialing to include delegation rosters
• Coordinate with internal staff and external entities to resolve issues related to provider enrollment and credentialing.
• Monitor and track the status of provider applications, payer directories, conducting regular follow-up with health plans until verification of completion is received from each payor.
• Support the enrollment and delegation team with various tasks as needed.

What We’re Looking For:   

• Strong organizational and time management skills, with the ability to manage multiple tasks and meet deadlines.
• Excellent attention to detail and accuracy in data entry and record-keeping.
• Effective communication skills, both written and verbal, with the ability to interact professionally with providers, staff and external entities.
• Ability to work independently and as part of a team, demonstrating flexibility and adaptability.
• Strong problem-solving skills, with the ability to identify and resolve issues promptly and effectively.
• Knowledge of healthcare regulations and compliance requirements.
• Familiarity with NCQA, URAC, and CMS standards.

Your Qualifications:  

• Associate degree, preferred
• High School diploma or GED required.
• 3-5 years of experience in payer enrollment.

Please note, the compensation/salary range provided in this posting is an hourly pay range. 

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