Provider Enrollment and Analytics Specialist (Remote)

Quest Diagnostics; Clifton (NJ); Remote; USD 72,000 - 100,000; Full time

Job summary

A leading company in healthcare seeks a Provider Enrollment Specialist for a remote position. The role involves managing provider enrollment applications and ensuring compliance with Medicare and Medicaid requirements. The ideal candidate has 3+ years of relevant experience and strong analytical skills to support this essential function.

Benefits

Medical, dental & vision benefits

401(k) with company match

Annual performance bonus

Flexible Spending Accounts

Education assistance

Qualifications

• 3+ years' relevant experience in healthcare organizations.
• Knowledge of Medicare and Medicaid provider network requirements.

Responsibilities

• Manage and complete activities related to Provider Enrollment applications.
• Engage with stakeholders and payers to complete enrollment requests.
• Review and monitor credentialing reports.

Skills

Analytical skills

Interpersonal skills

Problem-solving skills

Written communication

Attention to detail

Technical skills in MS Word

Technical skills in Excel

Education

Bachelor’s Degree

Job description

Overview

Provider Enrollment Specialist (remote)

Pay Range: $72,000 - $100,000 / year

Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

Benefits Information:

We are proud to offer best-in-class benefits and programs to support employees and their families in living healthy, happy lives. Our pay and benefit plans have been designed to promote employee health in all respects – physical, financial, and developmental. Depending on whether it is a part-time or full-time position, some of the benefits offered may include:

• Day 1 Medical, supplemental health, dental & vision for FT employees who work 30+ hours
• Best-in-class well-being programs
• Annual, no-cost health assessment program Blueprint for Wellness
• healthyMINDS mental health program
• Vacation and Health/Flex Time
• 6 Holidays plus 1 "MyDay" off
• FinFit financial coaching and services
• 401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
• Employee stock purchase plan
• Life and disability insurance, plus buy-up option
• Flexible Spending Accounts
• Annual incentive plans
• Matching gifts program
• Education assistance through MyQuest for Education
• Career advancement opportunities
• and so much more!

Manage, monitor and complete activities related to Provider Enrollment applications, revalidation updates and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers, for Quest, Diagnostics, its subsidiaries, joint ventures and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.

Responsibilities

• Review, prepare and submit requests for Medicare, Medicaid, and Health Plan payers to include completion of but not limited to: provider enrollment applications, revalidation requests, NPI enrollments, licensure updates, CAQH physician credentialing, health plan credentialing, attestations, and disclosures of ownership
• Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations and Optum to successfully complete enrollment requests and related activities
• Engage with payers directly to discuss enrollment issues, inquiries, updates and due dates of enrollment applications
• Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer defined enrollment/re-enrollment deadlines
• Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
• Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and eSignature tools
• Other duties as assigned

Qualifications

Required WorkExperience:

• 3 + years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
• Relevant experience in large, complex organizations, commerciallab, or healthcare organizations

Skills:

• Strong analytical and problem-solving skills
• Strong interpersonalskills;ability to work with external clients and multiple levels internal
• Ability to handle confidential or sensitive information with discretion
• Strong written & verbal communication
• Strong attention to detail
• Strong technical skills in MS Word and Excel
• Able to multi-task and perform in a fast-paced environment
• Lominger’sCompetencies:
  • Customer Focus
  • Organizational Savvy
  • Learning on the Fly
  • Problem Solving
  • Dealing with Ambiguity
  • Drive for Results

Education:Bachelor’s Degree preferred

EEO

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.