Provider Enrollment Specialist in Brentwood, TN at Health Support Center

Date Posted: 5/18/2018

Job Snapshot

Job Description

Health Support Center

POSITION SUMMARY:

The Specialist, Provider Enrollment is responsible for requesting participation for providers in and with health plans to minimize the possibility of delay or non-payment of claims for services rendered by practitioners.
  • Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers.
  • Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released.  
  • Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing. 
  • Research payers for information on processes to enroll providers, contact representative information; and status of provider already in the system or not.
  • Update, monitor, and maintain CAQH database with all current provider information that is received from the Market Director.
  • Input and/or maintain data for provider to include but not limited to, initial input of provider demographics, per-sonal, medical documentation, effective dates, and comments. 
  • Maintain updated licenses, add locations and various groups.   
  • Monitor and maintain provider files to determine reason for pending enrollment and/or acknowledge all docu-ments are received; request any documents and user names/passwords needed for enrollments; routinely update status changes.
  • Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner. 
  • Communicate and provide updates to designated market contacts. Research payer enrollment questions and issues raised by market representative and /or providers and respond with resolution.

Job Requirements

The requirements listed below are representative of the knowledge, skills and/or abilities required for the job: 
  • High School Diploma or GED equivalency.
  • Minimum of 2 years experience in Insurance Payer Background and/or Enrollment preferred.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

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