Provider Enrollment Specialist (Full Time - Hybrid)

POSITION SPECIFICS
Title:  Provider Enrollment Specialist
FTE:  1.0 FTE (40 hours per week)
Schedule:  Monday - Friday, 8:00AM - 4:30PM
Holiday Rotation: None
Weekend Rotation: None
On Call Requirements: None

POSITION SUMMARY
Under the general direction of the Business Services Supervisor the Provider Enrollment Specialist is responsible for payor provider enrollment for all medical staff.  The provider enrollment specialist is also responsible for the timely completion of government, managed care and commercial payor applications for the organization.  This includes preparing applications and following up with providers to ensure timely form completion of enrollment.  This position has direct contact with providers and insurance companies to resolve enrollment issues.  The specialist is responsible for researching and analyzing denial relative to enrollment/credentialing and to ensuring accuracy and following up with the insurance company regarding any discrepancies. 

POSITION TECHNICAL RESPONSIBILITIES

1. Responsible for provider and group enrollment for Sauk Prairie Healthcare.
2. Assist providers through the entire payor enrollment process to ensure all enrollments are completed timely.
3. Coordinate and manage credentialing data needed for enrollment. This includes Medical Degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, Curriculum Vitae (CV )and liability insurance.
4. Maintain communication with clinical departments and human resources relative to start dates and/or any delays in enrollment time frames.
5. Maintain provider credentialing files electronically via provider enrollment software and Council for Affordable Quality Healthcare (CAQH.)
6. Monitor all existing enrollments and complete re-credentialing as needed.
7. Communication with insurance payors to resolve provider enrollment issues.
8. Monitor claim edits and analyzing denials relative to provider enrollment issues.
9. As needed, appeal denials with insurance companies as needed.

POSITION REQUIREMENTS

Education:

• Required: High school degree or equivalent
• Preferred: Associate’s Degree in Accounting, Business, Health Information Management, or related field

Experience:

• Required: None
• Preferred: 1 to 3 years with provide enrollment or provider credentialing

Licenses and Registrations:

• Required: None
• Preferred: None

Certification(s):

• Required: None
• Preferred:  None

BENEFIT SUMMARY

1. Competitive health and dental insurance options
2. Flexible paid time off to balance work and life
3. Retirement plan with immediate vesting and employer match
4. Free membership to our state-of-the-art fitness facility
5. Generous tuition reimbursement
6. Employer provided life and disability insurance
7. Free parking at facility

Join Us!
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