Provider Enrollment Specialist

i3 Verticals - Metairie, LA

Full-time - Entry Level

Metairie, LA

Credit Intermediation and Related Activities

About the position

The Provider Enrollment Specialist/Credentialing is responsible for all aspects of provider/payer enrollment, re-enrollment, re-credentialing, re-validation, and contracting processes for medical providers in both private practice and group settings across various states. This role involves preparing and submitting applications for initial enrollment, handling re-credentialing and re-validation applications, and ensuring thorough follow-up to guarantee the completion of all enrollment processes. The specialist will document and maintain a detailed log of all pending and completed work in the enrollment software, maintain CAQH profiles for multiple providers, acquire and process new Managed Care Agreements, and assist with EDI and EFT procedures for certain payers. The position requires maintaining strict confidentiality and following established policies and procedures as outlined in the Employee Handbook, ACS Practice Management, Compliance, and HIPAA Manuals.

Responsibilities

• Prepare and submit governmental and private payer applications for initial enrollment across various state plans.
• Handle re-credentialing and re-validation applications for providers and groups for governmental and private payers.
• Ensure thorough follow-up to guarantee the completion of all enrollment processes.
• Document and maintain a detailed log of all pending and completed work in the enrollment software.
• Maintain CAQH profiles for multiple providers and provider types.
• Acquire and process new Managed Care Agreements.
• Assist with the process of applying and maintaining EDI and EFT procedures for certain payers.
• Provide support to providers and internal teams as needed regarding enrollment status and requirements.
• Maintain strictest confidentiality.
• Follow established policies and procedures listed in the Employee Handbook, ACS Practice Management, Compliance and HIPAA Manuals.

Requirements

• High school diploma or GED.
• Knowledge and understanding of the provider/payer enrollment process.
• Knowledge of Governmental and Private Provider enrollment processes and applications for Louisiana and other States.
• Knowledge of CAQH.
• Knowledge of CMS Federal and State Guidelines.
• Knowledge of license verifications for various provider types.
• Proficient use of Microsoft Office Word, Excel, and Outlook.
• Knowledge of grammar, spelling and punctuation to type correspondence.