Provider Enrollment Specialist
Medium, New York, NY, United States
Position Summary
The Provider Enrollment Specialist, Medicaid, has primary responsibility for oversight and maintenance of the professional and facility enrollment process. This includes submission of both online and paper applications and handling patient health information (PHI) while maintaining extreme privacy and security of confidential and proprietary information.
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 and ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations.
Submit re-enrollment applications in a timely manner to keep hospitals/physicians 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 the work queue to ensure all timely submissions and deadlines for all payor-specific forms and documents to the various health plans, including license updates, deficiency notifications, approval letters, etc.
Maintain the provider file and communicate provider changes, corrections, and terminations documented in the database.
Requirements and Qualifications
High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
At least 1 year of experience in the healthcare field working in billing or collections.
At least 1 year of client-facing/customer services experience.
Intermediate level understanding of insurance payer/provider claims processing and associated data requirements.
Thorough understanding of enrollment requirements and documentation needed for 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.
Strong computer proficiency and ability to use basic office applications, including MS Office (Word, Excel, Outlook).
Regular and predictable attendance.
Computation of essential duties satisfactorily; reasonable accommodations may be made for qualified individuals with disabilities.
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 and handles stress 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 a stationary position 50% of the time.
Occasionally moves about inside the office to access office equipment.
Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone, and computer.
Equal Opportunity Employer EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital status, disability, or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
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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 and ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations.
Submit re-enrollment applications in a timely manner to keep hospitals/physicians 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 the work queue to ensure all timely submissions and deadlines for all payor-specific forms and documents to the various health plans, including license updates, deficiency notifications, approval letters, etc.
Maintain the provider file and communicate provider changes, corrections, and terminations documented in the database.
Requirements and Qualifications
High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
At least 1 year of experience in the healthcare field working in billing or collections.
At least 1 year of client-facing/customer services experience.
Intermediate level understanding of insurance payer/provider claims processing and associated data requirements.
Thorough understanding of enrollment requirements and documentation needed for 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.
Strong computer proficiency and ability to use basic office applications, including MS Office (Word, Excel, Outlook).
Regular and predictable attendance.
Computation of essential duties satisfactorily; reasonable accommodations may be made for qualified individuals with disabilities.
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 and handles stress 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 a stationary position 50% of the time.
Occasionally moves about inside the office to access office equipment.
Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone, and computer.
Equal Opportunity Employer EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital status, disability, or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
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