Demo

Provider enrollment specialist

T3Cogno
Houston, TX Full Time
POSTED ON 3/14/2025
AVAILABLE BEFORE 9/9/2025

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

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