Provider Enrollment Specialist

St. Luke’s Health Network, Inc.; Allentown (Lehigh County); On-site; USD 40,000 - 60,000; Full time

Job summary

St. Luke's University Health Network seeks a Provider Enrollment Specialist to manage initial and re-credentialing submissions to payers. Responsibilities include licensing, group enrollments, and maintaining enrollment data accuracy for successful claim processing.

The role requires strong customer service, excellent communication, and proficiency with Microsoft Office. Collaborative teamwork and timely resolution of enrollment issues are essential.

Qualifications

• High School Education required.
• Experience with personal computers and the Microsoft Office suite of products is required.
• Strong customer service skills and excellent verbal and written communication skills.
• Detail- and service-oriented with good data-entry abilities.

Responsibilities

• Prepares provider enrollment applications and/or written link letters to be sent to payers.
• Ensures re-credentialing for providers with payers on a timely basis.
• Makes and receives calls to resolve payer issues and verify participating status.
• Updates and maintains enrollment tracking database with dates, numbers and demographics.
• Scans and files paperwork for tracking and submission proof to payers.
• Creates and submits new group enrollment applications for new or moved practices.

Skills

Customer service

Communication skills

Attention to detail

Verbal communication

Written communication

Education

High School Education

Tools

Microsoft Office Suite

Microsoft Word

Microsoft Excel

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Provider Enrollment Specialist ensures that initial and re-credentialing applications for St. Luke's University Health Network (SLUHN) employed providers' are submitted to identified third party and government health insurance carriers. Responsibilities also include maintaining membership and renewal information for professional and DEA licenses, board certification and professional organization memberships.

JOB DUTIES AND 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.

PHYSICAL AND SENSORY REQUIREMENTS

Requires sitting for up to eight hours per day, including extensive use of computer terminal and telephone. Requires hearing as it relates to normal conversation and answering questions in large groups. Requires seeing as it relates to general near and far vision.

EDUCATION

High School Education

TRAINING AND EXPERIENCE

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.

St. Luke's University Health Network is an Equal Opportunity Employer.