[Hiring] Provider Enrollment Specialist @Pediatrix

Role Description

The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Provider Enrollment Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates as needed to the appropriate RCM central business offices. The Provider Enrollment Specialist II will assist Management in maintaining provider enrollment goals for all divisions.

• Validates up-to-date plan enrollment forms, completes applications, submits them to plans and follows up until enrollment is complete.
• Verifies accuracy and coordinates entry of new and revised provider information into IntelliCred and Master Database.
• Maps forms in IntelliCred and prioritizes work, reviewing and researching Health Plan Enrollment requirements at Corporate Business Office.
• Documents assignments in the Credentialing/Provider Enrollment tracking system per the department’s standard operating procedures.
• Contacts health plans to determine enrollment requirements periodically and verify health plan requirements based on the specialty.
• Confirms the most up-to-date enrollment application forms are readily available in Provider Enrollment Tracking Software (IntelliCred).
• Prepares/reviews group applications based on information provided during acquisitions, Tax ID mergers, and Organic Growth Initiatives (OGI).
• Communicates with Business Development, Business Integration, and Credentialing to acquire prospective new provider group’s required documents and/or signatures as needed.
• Knowledgeable in reporting system functionality, mapping forms utilizing Provider Enrollment tracking software and IC system Q/A delegate.
• Maintains provider’s profile in PE Tracking system (IC) with up-to-date information on active or pending providers.
• Maintains provider’s profile in CAQH with up-to-date information on active or pending providers.
• Monitors all assigned delegated agreement health plan enrollments reports to ensure timely processing.
• Validates status of onboarding provider’s enrollments to ensure Target Start Date is met.
• Escalates to Provider Enrollment management when necessary to meet desired Target Start Date.
• Performs other job-related duties within the job scope as requested by Provider Enrollment Management.

Qualifications

• Associate's degree (A. A.) or equivalent from two-year college or technical school.
• Three (3) or more years related experience or equivalent combination of education and experience.
• Knowledgeable with Group Entity health plan enrollments, state regulations, and appeal processes.
• Knowledgeable in Provider Enrollment policies and procedures.
• Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Ability to write speeches and articles for publication that conforms to prescribed style and format.
• Ability to effectively present information to top management, public groups, and/or boards of directors.
• Ability to work with mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form.
• Ability to understand medical terminology and protocols.

Requirements

• Experience in Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue (Entity database software).
• Experience with CAQH and Credentialing/Provider Enrollment Tracking Software (IntelliCred).

Benefits

• Comprehensive benefits including Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, and HSAs.
• 401k plan and Employee Stock Purchase Program.
• Some benefits are provided at no cost, while others require a cost share between employees and the company.
• Voluntary plans available with convenient payroll deductions.