Analyst, Provider Enrollment

Duties

• Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines.
• 65% May perform any or all of the following in the enrollment of providers : determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth review and verification / validation of provider data; verifies provider data by use of information databases and various organizations / agencies to ensure authenticity; sets up / tests EFT accounts. Processes / enters / updates provider data information / applications into appropriate enrollment database used in evaluating / tracking the processing of the application and / or updating of provider directories.
• 20% Provides quality service and communicates effectively with external / internal customers in response to inquiries (correspondence, telephone). Obtains information from internal department, providers, government and / or private agencies, etc. to resolve discrepancies / problems. Supplies enrollment applications and general information on the enrollment process to interested enrollees.
• 10% Contributes to and participates on special projects related to provider files. Assists Technical Support staff with testing system changes related to provider files. Assists with process improvements related to Provider Enrollment.
• 5% Assists with provider education and provider services training.

Required Skills and Abilities :

Required