Provider Enrollment Specialist
The Provider Enrollment Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and for performing the tracking and follow-up required until providers are established and linked to the appropriate EMHS group entity.
• Manage the successful completion and submission of provider enrollment applications
• Perform tracking and follow-up to ensure providers are established and linked to the appropriate EMHS group entity in a timely manner
• Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations.
• Maintain documentation and reporting regarding provider enrollments in process
• Maintains provider enrollment files electronically via EMHS credentialing software, shared computer files and CAQH (Council for Affordable Quality Healthcare)
• Work closely with departments credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
• Ensure that established provider IDs and effective dates are communicated to appropriate billing and revenue departments so claims can be processed for submission.
Competencies and skills:
* Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
* Word processing, spreadsheets, data entry, database experience and other computer related skills.
* Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
* No previous experience required.
* High School Diploma/General Educational Development (GED)