What are the responsibilities and job description for the Provider enrollment specialist position at T3Cogno?
Location: Fully remote role with expected work hours from 8:30 AM to 5PM CT Mon-Fri.
Job Description:
The Provider Enrollment Specialist will be responsible for coordinating the requests for participation in health insurance network as a medical provider, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliance manner with all government and commercial payors. They will also review provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements.
Job Responsibilities:
● Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
● Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified. Maintains positive working relationships with providers.
● Plays an active role in explaining providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes.
● Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
● Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data.
● Proactively obtains updated provider credentialing data prior to expiration. Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions. Completes all additions, updates, and deletions. Supports new provider onboarding processes as related to enrollment.
● Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
● Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management.
● Continuously searches for process improvements to achieve accuracy and efficiencies.
● Performs other duties as assigned or required.
Skills and Education:
● High School Diploma or equivalent
● 3 years of experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements
● Experience with provider enrollment auditing and quality assurance
● Experience with California Medicaid enrollments
● Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools.
● Motivated to quickly learn and demonstrate strong problem-solving skills.
● Strong project management and multitasking skills.
● Excellent interpersonal and communication skills.
● Strong writing skills and attention to detail.
● Strong organizational skills and ability to be attentive to details.
● Demonstrated knowledge of healthcare contracts preferred
Company Benefits and Perks:
Joining organization comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.
● Access to a 401(k) Retirement Savings Plan.
● Comprehensive Medical, Dental, and Vision Coverage.
● Paid Time Off.
● Paid Holidays.
● Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.
● Must have California market experience (such as MediCal or BCBS-CA)
● Must have California Medicaid experience
● Must have provider enrollment quality assurance and auditing experience
Interested candidates can share their resume to chaitanya.chadha@t3cogno.com or natania.c@t3cogno.com
Or whatsapp to 91-9901436616/91-9108842716