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St. Luke's University Health Network - Allentown, PA
posted 2 months ago
About the position
The Provider Enrollment Specialist at St. Luke's University Health Network plays a crucial role in ensuring that employed providers' initial and re-credentialing applications are submitted to third-party and government health insurance carriers. This position is dedicated to maintaining accurate membership and renewal information for professional licenses, board certifications, and organizational memberships, thereby supporting the organization's mission to provide excellent care and improve access to healthcare services.
Responsibilities
- Prepares provider enrollment applications and written link letters to be sent to payers.
- Ensures timely re-validation of providers and groups with payers by completing re-credentialing applications.
- Makes and receives phone calls from providers and practice managers to resolve payer issues and verify participating status.
- Updates and maintains a database for enrollment tracking, effective dates, provider numbers, and demographics.
- Scans and files paperwork and documents for tracking and proof of submission to payers.
- Applies for New Jersey licensure for identified providers.
- Creates and submits new group enrollment applications for newly opened or relocated practices.
- Fields and responds to inquiries from SLUHN departments regarding enrollment issues.
- Ensures resolution of enrollment issues to assist with claim processing in the billing department.
- Identifies and communicates current or potential enrollment issues that could impact revenue or patient satisfaction.
- Participates in team meetings and conference calls with payers.
- Completes online applications for Doing Business As (DBA) for new or renamed groups.
- Creates check requests for out-of-state enrollment fees.
Requirements
- High School diploma or GED required.
- Experience with personal computers and the Microsoft Office suite is required.
- Strong customer service skills are essential.
- Excellent verbal and written communication skills are necessary.
- Detail-oriented and service-oriented approach.
