The Provider Enrollment Specialist II will be responsible for the larger and /or overarching functions of the provider enrollment credentialing process they manage within team territories they are assigned such as larger payors, special tasks, Government payors or Provider Liaison services.

Responsibilities:

For Provider Enrollment Specialist II with larger payors, team tasks or Government payor responsibilities:

• Complete and accurately submit provider enrollment applications, spreadsheets, and letters

• Research & keep current on payer, hospital, ASC & office-based guidelines as needed to ensure processes are accurate.

• Review and create workflows to identify accuracy, efficiency, and best practices.

• Assist provider enrollment credentialing staff in their zone/region, monitor workflows, and provide support and training as required

• Follow up with payors to ensure timely enrollment, re-enrollment, and participation

• Review and follow up on weekly billing reports

• Data entry of all provider information into the Credentialing Database

• Handle incoming requests from physicians, payors, and other agencies

• Verify integrity of data

• Oversee the completion of online provider CAQH re-attestations

• Assist with the development and maintenance of departmental policies and procedures

• Assist/lead new business implementations

• Assist in internal departments by resolving payment and denial issues as it relates to credentialing

• Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents as needed

• Facilitate and attend meetings and seminars as required

• Produce weekly and monthly productivity and issues report for management

• Other responsibilities as assigned

For Provider Enrollment Specialist II that manage Provider Services liaison responsibilities for the team:

•  Be able to initiate and act as liaison between providers and all Specialists within their territory/group with professionalism, respect and within time frames to maximize efficiencies

• Assist credentialing staff in their zone/region, monitor workflows, and provide support and training as required

• As region/zone Provider Services point person, assist, and interact with Regional Clinical and Operational leadership by assisting with resolving any provider enrollment issues, questions or concerns and/ or expedite processes for enrollment processes

• Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents as needed

• Facilitate and attend meetings and seminars as required

• Produce weekly and monthly productivity and issues report for management

• Other responsibilities as assigned

Qualification/Requirement:

• Positive and professional attitude

• Ability to work with all levels of associates from entry level to upper-level management

• Ability to work independently or in a group setting

• Previous credentialing or enrollment experience a plus

• Strong knowledge of provider enrollment credentialing in a physician office, managed care or hospital setting

• Must be a self-starter and a team player who enjoys providing the highest level of customer service.   

• Experience working with databases, and ability to create and manipulate excel spreadsheets

• Ability to multi-task and prioritize in a fast-paced environment

• Strong communication and follow up skills

• Professional business sense and leadership skills

• Strong experience with Microsoft Office (Excel & Word specifically)

• Local & distance travel may be required.

Education and/or Experience

• Associates Degree, Bachelor’s Degree, and/or equivalent work experience.  A minimum of three years provider enrollment/credentialing experience.

Total Rewards

• Salary: $19.39-$26.66 hourly

• Generous benefits package, including:

• Paid Time Off

• Health, life, vision, dental, disability, and AD&D insurance

• Flexible Spending Accounts/Health Savings Accounts

• 401(k)

• Leadership and professional development opportunities