The Provider Enrollment Specialist is responsible for organizing, maintaining, and verifying all aspects of the provider enrollment process for physicians and facility providers. This role ensures enrollment data is accurate and current, supports payer enrollment and revalidation activities, and helps prevent billing disruptions caused by enrollment or network status issues.
Key responsibilities include:
- Complete and submit enrollment forms to commercial insurers, Medicare, and Medicaid
- Work directly with insurance companies to track progress, answer questions, and resolve delays
- Keep provider databases updated with current licenses, certifications, NPI numbers, and practice locations
- Manage periodic re-enrollment and revalidation requirements to prevent lapses in billing status
- Research and correct billing rejections caused by enrollment or network status errors
- Maintain accurate payer enrollment information for active EHR systems
- Maintain attestations and consent forms with payers, networks, and databases
- Provide requested documentation to payers and networks
- Coordinate with payers and networks in the local area and surrounding areas
- Protect confidential information and follow HIPAA privacy and security requirements
- Follow infection-control policies and PPE requirements
- Perform other related duties as assigned
Requirements & Qualifications
Minimum Qualifications
- High School Diploma or GED equivalent required
- 1-3 years of experience in a medical office, hospital administrative department, medical billing, or health insurance coordination/processes required
- Understanding of medical terminology
- Familiarity with federal Provider Enrollment, Chain and Ownership System (PECOS) preferred
- Experience navigating the CAQH Provider Data Portal preferred
Essential Job Functions
- Regular and predictable attendance
- Ability to sit, bend, stoop, and stretch regularly
- Manual dexterity and eye-hand coordination sufficient to operate office equipment
- Ability to hear and see well enough to record, prepare, and communicate reports
- Ability to read and interpret reports and data
- Prolonged periods sitting at a desk and working on a computer
- Ability to access and navigate throughout the department and facility
Work Environment
- Works in a hospital setting and typical office conditions
- May be required to work all shifts, including weekends and holidays, based on departmental needs
- May be required to travel to other facilities for training
Location
Idaho, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago
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