Provider Enrollment Specialist
Direct Jobs, Florida, NY, United States
Responsibilities
Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The specialist monitors progress, ensures timeliness of enrollment completion, and provides updates to the appropriate central business offices. This role also assists management in maintaining enrollment goals across divisions.
Validate up-to-date plan enrollment forms, complete applications, submit them to plans, and follow up until enrollment is complete.
Verify accuracy and coordinate entry of new and revised provider information into IntelliCred and the Master Database.
Map forms in IntelliCred, prioritize work, and research Health Plan Enrollment requirements at the Corporate Business Office.
Document assignments in the Credentialing/Provider Enrollment tracking system per departmental SOPs.
Contact health plans to determine enrollment requirements periodically and verify the most up‑to‑date application forms are available in IntelliCred.
Prepare/review group applications based on acquisitions, Tax ID mergers, and Organic Growth Initiatives.
Communicate with Business Development, Integration, and Credentialing to acquire required documents or signatures from prospective provider groups.
Operate the Provider Enrollment Tracking system and IC Q/A delegate, maintaining provider profiles with accurate demographics and service data.
Monitor delegated health plan enrollment reports (To‑Do list, IntelliReports, IC Weekly aging, End of Month) to ensure timely processing.
Validate onboarding enrollments, ensuring target start dates are met and escalating to management when necessary.
Perform other job‑related duties within the scope of the role as requested by Enrollment Management.
Qualifications Education/Experience
Associate's degree (A.A.) or equivalent from a two‑year college or technical school.
Three (3) or more years of related experience, or an equivalent combination of education and experience.
Knowledge/Skills
Knowledge of Group Entity health plan enrollments, state regulations, and appeal processes.
Knowledge of Provider Enrollment policies and procedures, ensuring adherence and minimizing revenue loss from delays.
Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
Ability to respond to inquiries or complaints from customers, regulatory agencies, or the business community.
Ability to write speeches and articles conforming to prescribed style and format.
Ability to effectively present information to top management, public groups, and boards of directors.
Ability to work with mathematical concepts (probability, statistics, geometry, trigonometry) and apply fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret technical instructions in mathematical or diagram forms and handle abstract and concrete variables.
Understanding of medical terminology and protocols.
Software
Experience with Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue (Entity database software).
Proficiency in CAQH and Credentialing/Provider Enrollment Tracking Software (IntelliCred).
Benefits and Compensation We offer comprehensive benefits across a vast array of plans, including Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, HSAs, a 401(k) plan, and an Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.
Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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Validate up-to-date plan enrollment forms, complete applications, submit them to plans, and follow up until enrollment is complete.
Verify accuracy and coordinate entry of new and revised provider information into IntelliCred and the Master Database.
Map forms in IntelliCred, prioritize work, and research Health Plan Enrollment requirements at the Corporate Business Office.
Document assignments in the Credentialing/Provider Enrollment tracking system per departmental SOPs.
Contact health plans to determine enrollment requirements periodically and verify the most up‑to‑date application forms are available in IntelliCred.
Prepare/review group applications based on acquisitions, Tax ID mergers, and Organic Growth Initiatives.
Communicate with Business Development, Integration, and Credentialing to acquire required documents or signatures from prospective provider groups.
Operate the Provider Enrollment Tracking system and IC Q/A delegate, maintaining provider profiles with accurate demographics and service data.
Monitor delegated health plan enrollment reports (To‑Do list, IntelliReports, IC Weekly aging, End of Month) to ensure timely processing.
Validate onboarding enrollments, ensuring target start dates are met and escalating to management when necessary.
Perform other job‑related duties within the scope of the role as requested by Enrollment Management.
Qualifications Education/Experience
Associate's degree (A.A.) or equivalent from a two‑year college or technical school.
Three (3) or more years of related experience, or an equivalent combination of education and experience.
Knowledge/Skills
Knowledge of Group Entity health plan enrollments, state regulations, and appeal processes.
Knowledge of Provider Enrollment policies and procedures, ensuring adherence and minimizing revenue loss from delays.
Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
Ability to respond to inquiries or complaints from customers, regulatory agencies, or the business community.
Ability to write speeches and articles conforming to prescribed style and format.
Ability to effectively present information to top management, public groups, and boards of directors.
Ability to work with mathematical concepts (probability, statistics, geometry, trigonometry) and apply fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret technical instructions in mathematical or diagram forms and handle abstract and concrete variables.
Understanding of medical terminology and protocols.
Software
Experience with Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue (Entity database software).
Proficiency in CAQH and Credentialing/Provider Enrollment Tracking Software (IntelliCred).
Benefits and Compensation We offer comprehensive benefits across a vast array of plans, including Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, HSAs, a 401(k) plan, and an Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.
Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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