Provider Enrollment Specialist

Position Summary:

The Payer Enrollment Team Member is responsible for assisting facilities with enrolling TeleSpecialists providers with Medicare, state Medicaid and commercial insurance carriers. The Payer Enrollment Team Member is responsible for maintaining current CAQH, PECOS and State Medicaid profiles. The Payer Enrollment Team Member also ensures that management is made aware of any issues with the provider profiles.

Essential Duties and Responsibilities:

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• Complete initial, reassignment and re-validation applications with Medicare for facilities and providers.
  
• Complete initial, reassignment and re-validation applications with various state Medicaid’s for facilities and providers.
  
• Ensure physician Medicare re-validation apps for Commercial insurance networks are completed on time.
  
• Maintain PECOS portal for providers, including approval of facilities and updating demographic information.
  
• Manage and Maintain NPPES portal for providers.
  
• Create, update, and maintain CAQH profiles for providers.
  
• Manage Practice Manager CAQH profile for all providers and facilities.
  
• Manage password updates for various enrollment portals, included but not limited to CAQH, Medicare and Medicaid.
  
• Updating and maintaining MD Staff with the progress of all activities.
  
• Complete facility payer enrollment paperwork for providers and return to the facility in a timely manner.
  
• Manage Availity portal for various insurance networks.
  
• Other duties as assigned.
  

Education/Experience:

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• Payer Enrollment experience required.
  
• Credentialing software experience required; MD Staff preferred.
  
• Experience with Joint Commission or National Committee for Quality Assurance preferred.