Provider Enrollment Specialist

Description

The Enrollment Specialist role is an integral part of PMC’s Telehealth division. This position is responsible managing and coordinating all functions related to enrolling Provider's with Payors, and ensuring the submission of contracts.

Duties and Responsibilities

The Enrollment Specialist duties shall include, but not be limited to, the following as it supports PMC’s 3Cs Mission of:

• Care – Provide the best possible patient care
• Compliance – Ensure the program operates within all regulations
• Community – Become a wonderful addition to your local community

Job Responsibilities

• Manages the timely and accurate submission of provider enrollment applications for all insurance types, including enrollment and reassignment of Medicaid.
• Tracks and updates enrollment statuses on a real-time basis.
• Maintains the timelines for all enrollment schedules and provides updates to others as needed.
• Updates and maintains CAQH profiles to ensure data is accurate, attestations are current, and do not expire.
• Coordinates the receipt and processing of all credentialing data needed for enrollment, contracting, and other related purposes.
• Works closely with providers to obtain missing documentation for provider’s enrollment. 
• Obtains required provider signatures and follows up with the carriers on documentation submitted.
• Responds to internal and external inquiries on enrollment and contract matters.
• Performs other duties as required or assigned within the scope of responsibility, including supporting other functions and teams within the Revenue Cycle.

Requirements

• Two (2) years plus experience utilizing credentialing software such as Availity, CAQH, and/or Verity.
• Three (3) to five (5) years of credentialing experience working with commercial, Medicaid, and Managed Care providers.
• Must be proficient in Microsoft (Outlook, Teams) and Internet/Web.
• Experience with Verity or Athena is highly preferred.
• 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.
• Must be located within Mountain, Central, or Eastern time. 

Working Conditions

This job works in a professional office environment.

Physical Requirements

While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Direct Reports

This position does not have direct reports.

Reporting Structure

The Enrollment Specialist position reports directly to the Physician Services Director.