Provider Enrollment Specialist
Arkansas Children's, Little Rock, AR, United States
Work Shift
Day Shift
Time Type Full time
Department CC017690 Managed Care
Summary Monday through Friday, full-time hybrid position. There will be two weeks of training onsite.
Additional Information The Provider Enrollment Specialist facilitates the applications from a new/existing provider’s through all stages in order to enroll or re-validate the provider’s with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas.
Required Education High school diploma or GED or equivalent
Recommended Education Bachelor's degree in a related field of study.
Required Work Experience High School Diploma/GED, or 2 years of experience in lieu of a diploma/GED.
Responsibilities
Adheres to deadlines and enrollment schedules by tracking files through all stages.
Communicates with providers, payers, MSOs via email, phone, Teams and mail.
Helps the department move to paperless by centralizing all provider data gathered in software.
Maintains confidentiality and responsibility for all enrollment files through the process.
Maintains an organized database of physician information, ensuring accuracy and completeness.
Ensures that all enrollment activities adhere to healthcare regulations and organizational policies.
Collaborates with internal departments, including HR, legal, and billing, to facilitate the enrollment process.
Addresses and resolves enrollment-related issues and discrepancies promptly. Monitors and meets goals established for KPI metrics.
Generates reports and documentation related to physician enrollment, as needed. Maintains work queue for provider enrollment within HIS system.
Other duties as assigned.
Equal Employment Opportunity Arkansas Children's provides equal employment opportunity to all persons without regard to age, race, color, religion, national origin or citizenship status, disability, military status, sexual orientation, gender identity or expression, pregnancy or any other category protected by federal, state and local laws. Further, Arkansas Children's will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
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Time Type Full time
Department CC017690 Managed Care
Summary Monday through Friday, full-time hybrid position. There will be two weeks of training onsite.
Additional Information The Provider Enrollment Specialist facilitates the applications from a new/existing provider’s through all stages in order to enroll or re-validate the provider’s with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas.
Required Education High school diploma or GED or equivalent
Recommended Education Bachelor's degree in a related field of study.
Required Work Experience High School Diploma/GED, or 2 years of experience in lieu of a diploma/GED.
Responsibilities
Adheres to deadlines and enrollment schedules by tracking files through all stages.
Communicates with providers, payers, MSOs via email, phone, Teams and mail.
Helps the department move to paperless by centralizing all provider data gathered in software.
Maintains confidentiality and responsibility for all enrollment files through the process.
Maintains an organized database of physician information, ensuring accuracy and completeness.
Ensures that all enrollment activities adhere to healthcare regulations and organizational policies.
Collaborates with internal departments, including HR, legal, and billing, to facilitate the enrollment process.
Addresses and resolves enrollment-related issues and discrepancies promptly. Monitors and meets goals established for KPI metrics.
Generates reports and documentation related to physician enrollment, as needed. Maintains work queue for provider enrollment within HIS system.
Other duties as assigned.
Equal Employment Opportunity Arkansas Children's provides equal employment opportunity to all persons without regard to age, race, color, religion, national origin or citizenship status, disability, military status, sexual orientation, gender identity or expression, pregnancy or any other category protected by federal, state and local laws. Further, Arkansas Children's will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
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