<p>GENERAL SUMMARY:</p> <p>Under general supervision, responsible for all functions relating to ensuring that all appropriate practitioners are enrolled in government programs and commercial health plans. Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates. Responsibilities include data entry, data collection, analysis of information collected for appropriate enrollment.</p> <p>The Provider Enrollment Specialist must be knowledgeable to work in all aspects of the insurance provider enrollment process including initial enrollment, re-credentialing or revalidation. Provider Enrollment Specialist ensures providers are enrolled in accordance with current standards and regulations and must maintain stringent compliance with payers. The Provider Enrollment Specialist maintains excellent relations and is the main liaison between payers, clinics, and providers to assure participation status is managed in a timely and accurate manner.</p> <p>PRINCIPAL DUTIES AND RESPONSIBILITIES:</p> <ul> <li>Responsible for comprehensive and precise data entry for maintaining the accuracy of the enrollment database </li><li>Responsible for following department database standards for the documentation of all health plans and products, documents, and notes on incoming and outgoing attempts to obtain information and follow up conversations. </li><li>In depth working knowledge of various payor applications associated with the workflow process, i.e., Webdenis, CHAMPS, PECOS, CAQH. </li><li>Follows the Network Management workflow process in real time meeting required turnaround times and accuracy rates. </li><li>Verifies all required information and obtains necessary documents to ensure providers are processed according to current policies and procedure and ensure all files have a welcome, denial, or term letter, as appropriate. </li><li>Facilitates research and resolves denied claims & enrollment issues. </li><li>Possesses in depth knowledge of health plan standards and department operating procedures and effectively communicates issues, trends, concerns among team members and interdepartmental customers. </li><li>Communicates with internal and external customers in a clear, concise and professional manner to obtain or provide necessary information. </li><li>Organize and maintain practitioner files following confidentiality guidelines. </li><li>Participates in system integration and continuing quality improvement efforts. </li><li>Provides support and problem solving to Department Director in the development of short and long-range plans for the department, assuring overall continuity of the corporate strategic. </li></ul> <p>EDUCATION/EXPERIENCE REQUIRED:</p> <ul> <li>High School Diploma required. Associate's Degree preferred. </li><li>2 - 5 years of provider enrollment provider billing or credentialing experience required. </li><li>High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking. </li><li>Ability to work under minimal supervision. </li><li>Ability to perform detail work efficiently and with a high degree of accuracy. </li><li>High organized. </li><li>Strong business acumen. </li><li>Excellent verbal and written communication skills. </li><li>Ability to interpret information and make judgments quickly. </li><li>Ability to interact professionally with practitioners and other external customers </li><li>Strong quantitative and analytical skills. </li><li>Computer proficient in Microsoft Office including: Outlook, Word and Excel. </li><li>Proficient in EPIC, Morrisey. </li></ul> <p>CERTIFICATIONS/LICENSURES REQUIRED:</p> <p>None</p> <p>WORK ENVIRONMENT:</p> <ul> <li>Works in a normal office environment where there is no physical discomfort due to temperature, dust, noise, and the like. </li><li>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. </li><li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions </li></ul> <p>Additional Information</p> <ul> <li>Organization: Corporate Services </li><li>Department: Central Verification Office </li><li>Shift: Day Job </li><li>Union Code: Not Applicable </li></ul>