Provider Enrollment Specialist

Job Description

Job Description

The Provider Enrollment Specialist is responsible for preparing and submitting credentialing applications and supporting documentation to enroll individual Physicians and Advanced Practice Providers with payers. In this role, the Provider Enrollment Specialist follows up on the status of applications for Clinicians and payers and tracks the progress on all pending applications. The position requires integrity, attention to detail, dependability, initiative, and a commitment to embrace company values.

Essential duties and Responsibilities

Duties include but are not limited to:

• Re-enrolls and re-credentials providers employed by Providence Anesthesiology Associates.
• Reports all issues, scope of service changes, and progress updates to Director of Provider Relations
• Maintains the timelines for all enrollment/credentialing schedules and provides updates to providers and other departments as needed.
• Reviews Provider Profile information to determine enrollment issues, and reports on actions taken to resolve those issues.
• Coordinates the receipt and processing of all credentialing data needed for enrollment, contracting, and other related purposes.
• Works closely with clinicians and Director of Provider Relations to obtain missing documentation for providers pertaining to provider enrollment. Obtains required clinician signatures and follows up with the carriers on documentation submitted.
• Responds to internal and external inquires on routine enrollment and contract matters.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Minimum Qualifications

To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education: High School Diploma/Ged required.

Experience: Two (2) years of provider credentialing experience preferred.

License/Certification: CPCS – Certified Provider Credentialing Specialist or PESC – Provider Enrollment Specialist Certification preferred.

Language Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.

Computer Skills: Experience with medical billing software systems is recommended. Strong Microsoft Excel, Microsoft Outlook, Word, and PowerPoint is required.

Reasoning Ability: Ability to organize and manage personal workload. Ability to achieve and maintain strong working knowledge of anesthesia billing operation practices. Ability to develop and execute corrective action plans.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, use hands to finger, handle, or feel, reach with hands and arms, and talk or hear. The employee is occasionally required to sit or stand for long periods of time, some light lifting, computer, and desk work. Travel is primarily local, although some out of area and overnight travel for onboarding, training, and conferences may be required. Air travel may also be required.