Provider Enrollment & Credentialing Specialist

St. Luke’s University Health Network; Allentown (Lehigh County); On-site; USD 42,000 - 64,000; Full time

Job summary

St. Luke's University Health Network is seeking a Provider Enrollment Specialist to manage initial and re-credentialing applications with payers and maintain licensure for providers.

This role will also track enrollment data, communicate with practice managers, and ensure timely submission of enrollment materials. The position requires strong MS Office skills, excellent customer service, and clear written and verbal communication.

Qualifications

• Experience with personal computers and the Microsoft Office suite of products is required.
• Strong customer service skills.
• Excellent verbal and written communication skills.
• Detail and service oriented.

Responsibilities

• Prepares provider enrollment applications and/or written link letters to be sent to payers.
• Ensures all providers and groups are re-validated with payers on a timely basis by completing re-credentialing applications with current provider information and signatures.
• Makes and receives phone calls from providers and practice managers to help resolve payer issues and verify participating status.
• Updates & maintains database to show enrollment tracking, effective dates, provider numbers and correct provider demographics.
• Scans and files all paperwork and documents to a shared folder for tracking purposes 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 moving practices.
• Fields and responds timely to inquiries from SLUHN departments to help resolve enrollment related issues.
• Ensures SLUHN billing department has resolution on enrollment issues that assist with claim processing.
• Identifies and communicates current or potential enrollment issues that could result in loss of revenue and/or patient dissatisfaction.
• 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.

Skills

Customer service

Verbal communication

Written communication

Attention to detail

PC skills

MS Office

Education

High School Diploma

Tools

Microsoft Office

Job description

St. Luke's University Health Network is seeking a Provider Enrollment Specialist to manage initial and re-credentialing applications with payers and maintain licensure for providers.

This role will also track enrollment data, communicate with practice managers, and ensure timely submission of enrollment materials. The position requires strong MS Office skills, excellent customer service, and clear written and verbal communication.