Provider Enrollment Specialist Position

Job Description

Job Description

Greater Philadelphia Health Action, Inc. is a Federally Qualified Health Center known to be the largest healthcare provider in the greater Philadelphia area. With joint-commission accredited Health Centers providing compassionate and affordable healthcare services throughout Philadelphia regardless of an individual’s ability to pay.

We are presently seeking a Provider Enrollment Specialist to work in our Human Resources Department at GPHA’s Carl Moore Health Center.

The Provider Enrollment Specialist (PES) ensures the timely and accurate enrollment and recredentialing of all GPHA dental providers and, as needed, medical and behavioral health providers into various payer programs, managing both CAQH submissions and manual applications for plans like Delta Dental, Dentemax, Dominion Dental, and UHC Dental. The PES maintains provider numbers across all locations, collaborates closely with the Billing Department to share updates, resolve discrepancies, and attend biweekly meetings, and keeps all provider files, tracking databases, and practice management systems current. Responsibilities also include maintaining and updating the Dental Provider Enrollment Desktop Procedure (DPE DP), preparing reports, supporting policy updates, and responding to staff inquiries. Regular communication with the CHRO is required, and the PES must stay informed on healthcare industry changes affecting credentialing and enrollment.

Qualifications:

• Two to four years of college education plus a minimum of two years’ credentialing experience in a Health Center environment (or Managed Care Organization (MCO)), with a detailed understanding of provider enrollment and payment processes.
• OR A high school diploma or GED plus a minimum of four years’ experience in a Health Center environment (or MCO), with a detailed understanding of provider enrollment and payment processes. Good computer and analytical skills.
• Good computer and analytical skills.
• Good interpersonal and communication (both written and verbal) skills required.

Why Join Us?

• Make a tangible impact on underserved populations.
• Competitive salary and benefits package.
• Supportive, collaborative team environment.
• Remote work is possible upon satisfactory completion of probation.

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At Greater Philadelphia Health Action, Inc. (GPHA), we respect diversity and promote equity through action, advocacy, and policy through a dedicated team of representatives committed to listening, learning, and enacting systemic change. We create different channels, outlets, and programs to enhance safe spaces within GPHA, creating a shared understanding and language around justice, diversity, equity, and inclusion. GPHA is an Equal Opportunity Employer. GPHA does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, age, handicap, disability, religion, religious creed, ancestry, national origin, or any other basis prohibited by applicable law.