Provider Enrollment Specialist
United States Category Operations Job Id 44258 Remote
Application Instructions:
Make sure your resume has been customized to the Provider Enrollment Specialist role showing you are a good fit for the role as shown in the job description requirements and qualifications. Email your custom resume to me: [email protected]. I will review your resume. If there is a match then I will email you a link to the application with further instruction. When applying remember to select PACareerlink as your referral. After I sent the link and you apply then email to let me know so I can follow up on your application.Role Overview
The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider-related issues for claims suspended to Provider Enrollment. This role also executes the panel transfer process, completes assigned projects, and interacts with internal and external clients regarding provider maintenance activities.
Work Arrangement: Remote
Responsibilities
Communicate provider changes to appropriate providers, members, and internal departments within required timeframes. Coordinate provider mailings for all claims in the invalid provider queue that cannot be processed due to missing or invalid information. Research and resolve returned checks and provider mail. Assist providers and internal customers by responding to and resolving all inquiries related to Panel Transfers, Panel Releases, and Special Needs PCP assignment processes. Complete department reports, logs, and documentation as assigned. Ensure all work is completed in accordance with service level agreements (SLAs). Attend required annual training sessions and maintain compliance with organizational standards.Education & Experience
Associate's degree or equivalent work experience. Minimum of 1 year of related healthcare experience. Claims processing experience preferred. Knowledge of provider types and healthcare claims processes preferred.Skills & Abilities
Proficiency in Microsoft Office applications, including Word, Excel, Access, and Outlook. Experience with Facets software preferred. Strong attention to detail and organizational skills. Ability to communicate effectively with providers, members, and internal teams. Problem-solving and analytical skills for resolving provider-related issues.What's in it for you: Use your skills and experience to help others as well take advantage of our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
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