Provider Enrollment Specialist (Hollywood Corporate)

Provider Enrollment Specialist (Hollywood Corporate)

4000 HOLLYWOOD BLVD SUITE 215-S - HOLLYWOOD, FL 33021

Overview

Job Shift Day Travel Percentage Negligible Category Admin - Clerical

Description

Provider Enrollment Specialist

Dermcare Management has an excited opportunity for the right candidate in our Hollywood, Florida location. Our Enrollment Coordinator role is a full-time role that will offer major medical, dental vision and other ancillary benefits. The role could be hybrid remote. The role offers earn Paid Time Off that can be taken as soon as 90 days of employment.

The Enrollment Coordinator provides overall support to the Provider Enrollment Manager, as related to Provider enrollment, and other administrative tasks as assigned, while working closely with other departments including the Revenue Cycle team and Physician Credentialing.

Role Responsibilities:

• Perform the administrative and enrollment duties necessary to complete the provider enrollment process for Insurance purposes.
• Work directly with administrative contacts and departments which include: performing regular updates and communicating clearly on the status of the enrollment process to all departments and offices who require frequent updates.
• Provide superior customer service at all times to internal and external contacts including office managers, providers, payer representatives, and other staff members.
• Help with managing the onboarding process by working directly with providers to help facilitate the process of enrollment with insurance payers.
• Manage the enrollment/credentialing process from start to finish including obtaining applications from the payers, completing applications accurately, submitting applications timely per policy or within a reasonable time frame to avoid delays.
• Complete regular follow up with the payers to ensure applications are being processed, and obtaining confirmation once the credentialing/enrollment process is completed.
• Updating direct report on all completed applications.
• Act as liaison between practitioners and payers, identifying delays with payers, escalate and communicate delays or issues timely to management.
• Properly maintain files on each provider as required by the department, items may include (CAQH upkeep. Payor revalidations, verifications, practice updates and others as directed by management).
• Work closely with the other team members to ensure that the enrollment is handled as quickly and professionally as possible.
• Maintain knowledge of requirements for credentialing providers with contracted health plans.
• Provide consistent upkeep of provider enrollment status throughout the enrollment cycle and documenting each step of the process in the provider database (Modio).
• Audit and update health plan directories for current and accurate agency and provider information, as well as primary contacts.
• Generate and maintain weekly and monthly reports of credentialing and enrollment processes.
• Responds to staff, provider, payer and other stakeholder inquiries and requests in a timely manner.

Essential Functions:

• Physical Demands will include sitting, standing, walking, bending, stooping, squatting, kneeling, pushing/pulling, twisting, climbing stairs.
• Lifting to 10 pounds.
• Looking at a computer screen for up to 8 hours a day.

Benefits:

• Medical, Dental and Vision Insurance with FSA/HSA with in first 90 days.
• Ability to work a Hybrid Schedule.
• PTO accrued and ability to use after the first 90 days.
• 401K with matching.
• Working in a team environment.
• Onsite training directly with the Provider Manager.

Skills & Abilities:

• Extremely organized and flexible with the ability to simultaneously handle the enrollment and credentialing functions of the department.
• Sound work ethics with the ability to make independent decisions, be detail oriented with excellent written and verbal communication skills.
• Ability to interact with staff in a fast-paced environment, sometimes under pressure, remaining flexible, proactive, resourceful and efficient. Must be able to work in a Team oriented environment.
• Ability to exhibit a high level of professionalism and confidentiality.
• Excellent customer service skills and positive demeanor.

Qualifications

Qualifications & Experience Required:

• Must have a basic knowledge of healthcare credentialing, licensure, certification, and CAQH.
• Must have a knowledge of Provider Enrollment with Payors. An understanding of IPA's and PHO's is a plus but not required.
• Microsoft Office experience, specifically Excel.
• Modio experience is a plus.
• Experience working with health insurance, including CMS and Medical Assistance is a plus.
• 2-3 years of experience specifically related to Provider enrollment.