Provider Enrollment Specialist

Key Responsibilities

• Collect, verify, and submit information necessary for the enrollment of hospitals/physicians with Out-of-State Medicaid payers.
• Develop and maintain ongoing policy and procedures specific to each state for new hospital/physician enrollments.
• Maintain working knowledge of hospital/physician Out-of-State Medicaid enrollment requirements and regulations. Ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations.
• Submits re-enrollment applications in a timely manner to ensure hospitals/physicians are up to date with their enrollment status.
• Establish, maintain, and constantly review the accuracy of Out-of-State Medicaid requirements to ensure compliance with government rules and regulations.
• Manage work queue to ensure all timely submissions/deadlines of all payor-specific forms and documents to the various health plans including license updates, deficiency notifications, approval letters, etc.
• All maintenance of the provider file and communication of provider changes, corrections, and terminations documented in the database.

Requirements and Qualifications

• High School Diploma or GED required.  Associates or Bachelor’s Degree preferred.
• 1+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Thorough understanding of the enrollment requirements and documents needed for the accurate completion of applications
• Knowledge of general credentials and licenses is preferred but not required: hospital license, CLIA, DEA, NPI, board certifications, etc.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains stable performance under pressure or opposition.  Handles stress in ways to maintain relationships with all stakeholders.
• Must be a self-starter and able to work independently without direct supervision.
• Proven written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.
• Must be able to remain in stationary position 50% of the time.
• Occasionally moves about inside the office to access office equipment, etc.
• Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer.