Provider Enrollment Specialist

MCR Health, Inc; Bradenton (FL); On-site; USD 48,000 - 64,000; Full time

Job summary

The Provider Enrollment Specialist assists with all aspects of the insurance provider enrollment process for MCR Health, Inc. The Credentialing Specialist maintains relations with payers, clinics, and providers to ensure timely participation status and compliance.

Based in Bradenton, FL, this role supports provider enrollment for government programs and commercial networks. The position requires strong communication, medical terminology knowledge, and the ability to work with minimal supervision.

Qualifications

• Two years of healthcare insurance experience.
• Provider enrollment experience preferred.
• Knowledge of Medicaid, Medicare, and private insurance.
• Basic Microsoft Excel skills; advanced skills preferred.
• Strong interpersonal and written/oral communication.
• Ability to meet deadlines and work with minimal supervision.
• Medical terminology knowledge is helpful.
• High School Graduate or GED equivalent.

Responsibilities

• Complete insurance enrollment applications following standards, regulations, guidelines & laws.
• Responsible for initial credentialing with insurance companies.
• Ensure credentialing and re-credentialing is completed promptly for providers and the organization.
• Notify managers of credentialing issues, status on applications, changes with plans.
• Handle telephone communications regarding provider participation and documentation.
• Obtain signatures in the field to complete credentialing.
• Support the goals and mission of MCR Health.
• Adhere to safety policy; perform other duties as assigned.

Skills

Interpersonal skills

Microsoft Excel

Education

High School Diploma or GED

Tools

Microsoft Excel

Job description

Why MCR Health?

A career at MCR Health offers exciting opportunities with one of the largest Healthcare companies in the areas we serve. Now, more than ever, we are looking for exceptional people to support our passion to provide "Exceptional Care to Everyone, Every Time", and to support our Mission to serve everyone. Whether you are providing direct patient care or in other areas of our Company, you can find a home here. We invite you to be part of our Company where you can grow your career and serve with your heart.

In our time of Company growth, we are seeking a Provider Enrollment Specialist.

Work Location: Bradenton, Florida.

As Part Of This Role, You Will

• Complete insurance enrollment applications following the organization's standards, state & federal regulations, guidelines, procedures & laws required in the credentialing process
• Responsible for initial credentialing with insurance companies.
• Ensure that the credentialing and re-credentialing process is completed in its entirety promptly by individual providers, as well as by the organization.
• Responsible for notifying the appropriate managers of any credentialing issues, status on outstanding applications, changes with contracted insurance companies, and new plans within the company’s service delivery area.
• Handle telephone communications to answer credentialing and staff questions regarding provider participation, credentials, documentation, etc.
• Obtain signatures in the field as required to complete the credentialing process.
• Supports the goals and mission of MCR Health.
• Adheres to the safety policy of MCR Health.
• Performs other duties as assigned from time to time.
  
  

Requirements

What you need to bring to this role:

• High School Graduate or GED equivalent required.
• Must have two (2) years of Healthcare Insurance experience.
• Provider Enrollment experience preferred.
• Must have a working knowledge of Medicaid, Medicare, and private insurance.
• Must have basic Microsoft Excel skills. Advanced Microsoft Excel skills preferred.
• Must have experience and/or education in computer data entry
• Must have strong interpersonal skills in written and oral communication, problem-solving, and teamwork.
• Must have excellent grammar skills.
• Must be able to meet deadlines and complete assignments promptly.
• Medical terminology knowledge is helpful.
• Must be able to work with minimal supervision.
• Must be courteous, helpful, and maintain patient confidentiality.
  
  

Summary

The Provider Enrollment Specialist assists with all aspects of the insurance provider enrollment process for the organization. Enrollment includes both facility and professional providers participating in government programs and commercial payer networks. The Credentialing Specialist (Insurance) maintains excellent relations and liaisons between payers, clinics, and providers to assist in ensuring participation status is managed in a timely and accurate manner. He/she supports compliance & Principles of Responsibility, maintains confidentiality, protects organizational assets, and exhibits ethics & integrity.

• MCR Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.