Provider Enrollment Specialist

Description

Neighborhood Family Practice is a Federally Qualified Health Center (FQHC) dedicated to providing comprehensive, high-quality, and affordable healthcare to underserved and diverse communities. NFP’s mission is to deliver equitable and accessible care, fostering healthier lives and stronger communities.

Our Benefits include:

• Medical, Dental, Vision Insurance after 1 month of employment

• 403B with Company Match

• Paid Holidays and Paid Time Off

• And more!

Neighborhood Family Practice is committed to building healthy communities through high-quality healthcare. As an APP, you will have a number of opportunities to consider. NFP offers the opportunity to provide care to underserved and marginalized populations in a Community Health setting, contributing to personal and professional satisfaction.

Schedule: Monday - Friday, 8am to 4:30pm. Hybrid work environment after 90 days

Compensation: $45,000 ($21.63/hr) to $55,000 ($26.44) based on experience and skills

Position Summary:

The Provider Enrollment Specialist is responsible for the initial enrollment and credentialing, and re-enrollment and re-credentialinig for the organization and all healthcare providers with Medicare, Medicaid, and all commercial payers. The Provider Enrollment Specialist is also responsible for initial certification and revalidation of Medicare Parts A and B, Medicaid Parts A and B, and all commercial payers.

Essential Duties:

• Complete enrollment and re-enrollment applications for providers in a timely and accurate manner toe ensure active participation across payors. Regularly review and follow up on application status for providers and payers; receiving, tracking, and monitoring escalated issues.

• Collect, manage, and update accurate data for Providers via CAQH and other specific carrier requirements. Follow up with insurance carriers regarding provider/site enrollment, termination, or relocation status. Complete and monitor provider revalidations as needed.

• Prepare, submit, and manage Medicaid and Medicare master applications and revalidations for individual providers and sites.

• Maintain detailed provider enrollment files, including documents received electronically and hard copay documents, to document each stage of enrollment and re-enrollment process thoroughly. Maintain up-to-date and accurate credentialing spreadsheet and provide enrollment updates to Revenue Cycle, Billing, and Leadership team members as needed.

• Proactively research, respond to, and resove problems with provider network participation to minimize service denials and maximize reimbursement revenue.

• Serve as subject matter expert regarding current health plan and agency requirements for credentialing providers, including documentation requirements (DEA, license, CV, etc.) and other regulations.

• Complete EDI, ERA, and EFT enrollment for all applicable carriers.

• Other duties as assigned.

Qualifications

Experience and Education:

• 2 years experience in Payor Enrollment or Credentialing or similar experience required

• 1 years experience with Physician Billing

• High School Diploma, GED, or equivalent required

Skills and Knowledge:

• Highly organized, able to multi-task with a high degree of accuracy

• Ability to manage competing deadlines

• Strong communication skills, both verbally and in writing, including through the use of electronic communication devices.

• Proficient in Microsoft Office applications, CAQH, Availity, PECOs, and other Enrollment applications strongly preferred

• Knowledge of EPIC EMR/EHR software

Essential Physical Demands and Working Environment

• Able to sit, stand, pend, and stoop for extended periods of time.

• Office work environment with local travel between locations required

NFP is committed to equal employment opportunities for all individuals and does not discriminate on the basis of race, color, religion, national origin, sex, gender or gender identity, age, or any other basis protected by Federal, State, or Local Law. Reasonable accommodations will be made to allow individuals with disabilities to complete the essential duties of the position.

Salary : $45,000 - $55,000