Provider Enrollment Specialist

• Identify provider payer enrollment issues or denials with the Provider Enrollment Manager
• Research and resolve payer enrollment issues through proprietary and external tools
• Contact clients, operations personnel, CMS, and other payers by phone, email, or website
• Follow up with market locations to research and resolve payer enrollment issues
• Complete and submit CMS Medicare, State Medicaid, and third-party payer applications
• Track and follow up to establish provider numbers and link them to the appropriate client group entities and software systems
• Maintain documentation and reporting for payer enrollments in process
• Retain records related to completed CMS applications
• Build working relationships with clients, Operations, and Revenue Cycle Management
• Obtain, track, and manage payer revalidation dates; submit and track applications to maintain active enrollment and prevent deactivation
• Maintain provider demographics in applicable enrollment systems
• Add providers to applicable systems and maintain information so claims are held or released based on enrollment status
• Perform special projects and other assigned duties

• Enter, update, and maintain provider information in internal systems
• Validate provider credentialing data, contracts, and demographic data
• Ensure provider records comply with CMS, HIPAA, and state/federal regulations
• Conduct routine audits and reconciliations to maintain data integrity
• Review and load required data into the health plan system according to process guidelines
• Manage and monitor daily activities and meet set targets
• Work independently and complete tasks within established timeframes with minimal supervision
• Prioritize and complete all job duties
• Adhere to changes based on department and/or business requirements

Provider Data Management Specialist – Enrollment

• Complete Medicare, Medi-Cal, and other governmental provider enrollment application packets, not limited to California
• Complete non-governmental provider enrollment application packets, not limited to California
• Follow up routinely and confirm status of physician enrollment applications
• Maintain client/physician confidentiality
• Maintain effective communication and professional interaction with clients and physicians
• Navigate governmental and non-governmental websites

• Enter, update, and maintain provider information in internal health plan systems
• Validate provider credentialing data, contracts, and demographic information
• Ensure provider records comply with CMS, HIPAA, and state/federal regulations
• Conduct routine audits and reconciliations to maintain data integrity
• Review and load required data into the health plan system according to process guidelines
• Manage and monitor daily activities and meet set targets
• Work independently and complete tasks within established timeframes with minimal supervision
• Prioritize and complete all job duties
• Adhere to changes based on department and/or business requirements