Hazel Health · 6 hours ago

Provider Enrollment Specialist

United States

Full-time

Remote

Mid Level

$26.75/hr - $31.50/hr

3+ years exp

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Responsibilities

Manages the timely and accurate submission of provider enrollment applications for all insurance types, including enrollment and reassignment of Medicaid, Managed Medicaid, and commercial programs.

Tracks and updates enrollment statuses on a real-time basis in Salesforce HealthCloud.

Maintains the timelines for all enrollment/credentialing schedules and provides updates to providers and others as needed.

Reviews Provider Profile information to determine enrollment issues and reports on actions taken to resolve those issues.

Coordinates the receipt and processing of all credentialing data needed for enrollment, contracting, and other related purposes.

Works closely with clinicians to obtain missing documentation for providers pertaining to provider enrollment. Obtains required clinician signatures and follows up with the carriers on documentation submitted.

Responds to internal and external inquiries on enrollment and contract matters.

Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.

Performs other duties as required or assigned within the scope of responsibility, including supporting other functions and teams within Revenue Cycle.

Qualification

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Credentialing softwareSalesforce Health CloudMedicaid enrollmentGoogle SuiteCPCS certificationCPMSM certificationCommercial insurance portals

Required

Two (2) years plus experience utilizing credentialing software such as Availity, Modio and/or Verity.

Three (3) to five (5) years credentialing experience working with commercial, Medicaid and Managed Care providers

Must be proficient in Google Suite (gdocs, gsheets, gmail) and Internet/Web

Experience with Salesforce Health Cloud.

Experience navigating state Medicaid, Managed Medicaid, and commercial insurance portals

Ability to understand how job performance affects the outcomes of key performance indicators such as time to revenue and billing rates.

Self-motivated with excellent decision making and time management skills

Preferred

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification by the National Association of Medical Staff Services is strongly preferred

Associate Degree preferred