Provider Enrollment Specialist

• Drive the provider enrollment process from application receipt through directory inclusion, managing initial enrollment, re-credentialing, and revalidation with precision and efficiency
• Execute comprehensive and accurate data entry to maintain enrollment database integrity, ensuring all provider information is current and compliant
• Verify all required documentation and information, securing necessary materials to ensure providers are processed according to current policies and procedures
• Issue welcome, denial, or termination letters as appropriate, maintaining clear communication throughout the enrollment journey

• Demonstrate in-depth working knowledge of key payor applications including Webdenis, CHAMPS, PECOS, and CAQH, leveraging these tools to streamline workflow processes
• Execute the Network Management workflow in real time, consistently meeting required turnaround times and accuracy benchmarks
• Document all health plan activities, communications, and follow-up attempts according to department standards, creating a comprehensive audit trail
• Participate actively in system integration and continuous quality improvement initiatives to enhance departmental efficiency

• Serve as the primary liaison between payers, clinics, and providers, building strong relationships and ensuring timely, accurate management of participation status
• Research and resolve denied claims and enrollment issues, demonstrating strong analytical and problem-solving capabilities
• Communicate with internal and external stakeholders in a clear, professional, and concise manner, translating complex enrollment requirements into actionable information
• Organize and maintain practitioner files with meticulous attention to confidentiality guidelines and data security

• Develop in-depth knowledge of health plan standards and departmental procedures, effectively identifying and communicating issues, trends, and concerns to team members and cross-functional partners

• Develop in-depth knowledge of health plan standards and departmental procedures, effectively identifying and communicating issues, trends, and concerns to team members and cross-functional partners
• Support the Department Director in developing short and long-range strategic plans, contributing to departmental continuity and organizational objectives
• Demonstrate professional interactions with practitioners and external customers, representing the organization with integrity and expertise

• High School Diploma required. Associate’s Degree preferred.
• 2-5 years of provider enrollment provider billing or credentialing experience required.
• High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking.
• Ability to work under minimal supervision.
• Ability to perform detail work efficiently and with a high degree of accuracy.
• High organized.
• Strong business acumen.
• Excellent verbal and written communication skills.
• Ability to interpret information and make judgments quickly.
• Ability to interact professionally with practitioners and other external customers
• Strong quantitative and analytical skills.
• Computer proficient in Microsoft Office including: Outlook, Word and Excel.
• Proficient in EPIC, Morrisey.

• Works in a normal office environment where there is no physical discomfort due to temperature, dust, noise, and the like.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.