The Senior Enrollment Specialist plays a key role in overseeing the end-to-end payer enrollment process. This includes managing applications, ensuring compliance with enrollment requirements, and maintaining accurate records and data. As a Senior Specialist this role serves as a primary contact for enrollment inquires and addresses complex enrollment issues, playing a pivotal role in issue resolution.
- Responsible for overseeing, monitoring, and maintaining the processes involved in both initial and revalidation of payer enrollment applications.
- Possess a thorough comprehension of payer enrollment requirements and regulations governing enrollment to ensure ongoing compliance.
- Responsible for securing timely enrollment by submitting applications ahead of deadlines and maintaining consistent follow-up with payers through completion.
- Conduct research and document enrollment processes encompassing, but not limited to, initial enrollment, revalidation, and demographic changes.
- Regularly update and manage data in the credentialing database, spreadsheets, and folders, while maintaining data integrity.
- Assures compliance with payer requirements as related to the provider enrollment and monitor activities to ensure compliance with all procedures and regulations.
- Participate in the development and implementation of credentialing processes and procedures and provide input regarding process improvement.
- Serve as primary contact for payer inquires and issue resolution, specifically related to enrollment and credentialing matters.
- Assist in the training of colleagues on internal enrollment policies and procedures and provide guidance on navigating payer agencies requirements.
- Four to six years of experience in a credentialing office or equivalent related environments.
- Knowledge of health plan and governmental payer credentialing process and requirements, such as NCQA/state/federal standards, Medicaid, and Medicare.
- Demonstrates proficient communication abilities, both orally and in writing, and strong interpersonal skills.
- Exhibits a heightened level of awareness and attention to detail.
- Demonstrates outstanding organizational and time management skills.
- Demonstrate the ability to work autonomously while effectively contributing to a collaborative team environment.
- Proficient in Database, MS Excel, Word, Adobe and other software systems.
- A team player with multi-tasking capability and strong customer service orientation.
- Current Certified Provider Credentialing Specialist (CPCS) with the National Association of Medical Staff Services preferred.
- Database management skills including querying, reporting, and document generation a plus.
- Must possess ability to sit and/or stand for long periods of time.
- Majority of work is performed in a desk/cubicle environment.
- All job specific, safety, and compliance training are assigned based on the job functions associated with this position.
- All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.
Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer.
- Highly competitive and inclusive medical, dental and vision coverage options
- Health Savings Account for medical expenses and dependent care expenses
- Flexible Spending Account to pay for certain out-of-pocket expenses
- Paid time off, including: vacation, sick time and holidays
- LTD and STD insurance coverages, as well as voluntary benefit options