[Hiring] Provider Enrollment Associate @Geode Health

Role Description

Reporting to Credentialing Manager, the Provider Enrollment Associate is responsible for overseeing all credentialing, licensing, and payer enrollment tasks. The associate will work with providers and third-party partners to ensure all payer enrollment actions are completed in a timely manner while focusing on reducing overall enrollment related timelines. The Provider Enrollment Associate must be able to effectively communicate with providers and other internal/external customers.

• Act as a liaison to providers as well as any vendors to ensure all information required for credentialing, license verification and payer enrollment is obtained in a timely manner
• Provide credentialing and enrollment expertise for the organization
• Leverage expertise to develop third-party workers’ knowledge base through regular meetings and coaching
• Maintain accuracy of provider database including payer enrollment, licensure, and malpractice information
• Provide regular reporting of any delays in credentialing or enrollment processes
• Responsible for investigating and self-reporting issues, developing and implementing solutions to address existing issues and identifying processes to mitigate risk
• Assists in resolving payer enrollment related claim denials
• Continually monitor processes and outcomes to ensure established KPI’s for credentialing, licensure and enrollment tasks are met
• Provide feedback to Payer Contracting to ensure payer specific requirements are not only met, but optimized to reduce enrollment timelines
• Ability to learn and document regulations and rules for new states
• Other duties as assigned

Qualifications

• In-depth knowledge of credentialing, licensure, and payer enrollment requirements
• Experience using PECOS, CAQH, Availity and other payer portals
• Experience with EDI, ERA & EFT enrollments
• Proficient with MS Excel and PowerPoint

Requirements

• Associate degree or equivalent experience required; Bachelor’s Degree preferred
• 3-5 years’ experience working in provider enrollment

Benefits

• Competitive compensation
• Medical, dental and vision benefits
• Life insurance
• Short and long-term disability
• Paid vacation and holidays
• Matching 401k plan
• State of the art technology
• Flexible schedule
• In-person and virtual patient visits
• Comprehensive admin support (front office, accounting, finance, payroll, HR, etc)
• Professional development opportunities
• Clinical community, support, and leadership