Job Purpose
The Provider Enrollment Associate is responsible for credentialing/enrolling new and established health care providers and maintenance of required information.
Duties and Responsibilities
- Communicates with providers to explain process and sign applications
- Collects, updates, maintains necessary provider information and documentation and verifies the information where possible
- Establishes and maintains data entry in CAQH
- Prepares provider enrollment applications for all initial applications and re-credentialing in a timely and complete manner
- Verifies provider and group information with insurance companies (addresses, contracted plans, provider ID numbers, etc.)
- Coordinates information for enrollment and termination of all providers
- Handles enrollment with Medicare, Medicaid, commercial insurances
- Contributes to the departmental process and procedures with a collaborative approach
- Works department client WQ’s and smart feeds where applicable
- Maintains provider enrollment mailbox and completes actions and follow up
- Performs other duties as requested
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
- High School graduate or equivalent required
- Minimum two years of provider enrollment experience
- Knowledge of Microsoft Office Suite, Outlook, Excel, CAQH
- Billing knowledge and experience preferred
- Excellent verbal and written communication skills
- Strong interpersonal skills, ability to communicate well at all levels of the organization
- Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
- Gracious and welcoming personality for customer service interaction
Working Conditions
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
