156 applicants

Company

ROM Technologies, Inc. · 1 day ago

Enrollment Specialist

United States

Full-time

Remote

Mid Level

4+ years exp

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Hiring Manager

Nicole Hook

Insider Connection @ROM Technologies, Inc.

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Responsibilities

Complete and submit enrollment and revalidation applications for Medicare and Medicaid for new and existing healthcare providers.

Maintain knowledge of CMS regulations, including PECOS, revalidation timelines, and state Medicaid rules.

Monitor and track the status of enrollment applications and ensure timely follow-up to avoid payment disruptions.

Prepare, submit, and follow up on enrollment applications for commercial insurance carriers, ensuring that providers are credentialed accurately and within required timeframes.

Communicate with commercial payors to resolve issues related to credentialing, contracting, and enrollment delays.

Verify provider credentials and maintain credentialing files, ensuring all certifications, licenses, and board certifications are current and compliant with payor requirements.

Track and manage provider re-enrollments, revalidations, and expirations, ensuring all deadlines are met.

Maintain accurate provider data within credentialing software and databases, including NPI numbers, CAQH profiles, and state licensures.

Ensure proper documentation is uploaded and kept in a secure, accessible format.

Stay up to date with federal, state, and commercial insurance regulations to ensure compliance with all credentialing and enrollment processes.

Respond to internal and external audits, providing all necessary documentation and enrollment records.

Liaise between providers, payors, and internal departments to ensure effective communication regarding provider enrollment statuses.

Educate providers on the enrollment process and provide regular updates on the status of their applications.

Prepare regular reports on the status of provider enrollments, expirations, revalidations, and other key metrics for management.

Identify and report any delays, denials, or issues in the enrollment process and propose solutions for resolution.

Qualification

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Provider EnrollmentCredentialingMedicare RegulationsMedicaid RegulationsCommercial InsuranceCredentialing SoftwareHealthcare Revenue CycleCompliance Regulations

Required

High School Diploma or equivalent required.

4-6 years of experience in provider enrollment, credentialing, or billing with Medicare, Medicaid, and commercial insurance payors.

Exceptional communication skills, both written and verbal, with the ability to work with diverse teams and stakeholders and interact effectively with payors, providers, and internal teams.

In-depth knowledge of Medicare and Medicaid enrollment regulations, including experience & proficiency with credentialing systems and software (PECOS, CAQH, NPPES), and commercial payor credentialing processes.

Advanced knowledge of the healthcare revenue cycle, enrollment processes, and compliance with federal and state regulations.

Excellent organizational and problem-solving skills, with the ability to manage multiple priorities and projects simultaneously.

High attention to detail and the ability to ensure accuracy in all enrollment and credentialing activities.

Moderate noise (i.e., phone calls, online meetings, computer audio).

Ability to sit at a computer terminal for an extended period.

While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.

Specific vision abilities required by this job include close vision requirements due to computer work.

Regular, predictable attendance is required.