Provider Enrollment Specialist

TeleSpecialists; Brookhaven (GA); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Tuition reimbursement

Paid vacation

Leadership training

Job summary

TeleSpecialists in Brookhaven, GA seeks a Payer Enrollment Team Member to enroll TeleSpecialists providers with Medicare, state Medicaid and commercial carriers, and to maintain CAQH, PECOS and NPPES profiles.

You will complete enrollment applications, update provider demographics, manage CAQH and Availity portals, and ensure timely submissions. Payer enrollment experience and credentialing software experience are required; Joint Commission/NCQA experience is a plus.

Qualifications

• Payer Enrollment experience required.
• Credentialing software experience required; MD Staff preferred.
• Experience with Joint Commission or National Committee for Quality Assurance preferred.

Responsibilities

• Complete initial, reassignment and re-validation Medicare apps for facilities and providers.
• Complete initial, reassignment and re-validation apps with various state Medicaid’s for facilities and providers.
• Ensure physician Medicare re-validation apps for Commercial insurance networks are completed on time.
• Maintain PECOS portal for providers, including approval of facilities and updating demographic information.
• Manage and Maintain NPPES portal for providers.
• Create, update, and maintain CAQH profiles for providers.
• Manage Practice Manager CAQH profile for all providers and facilities.
• Manage password updates for various enrollment portals, included but not limited to CAQH, Medicare and Medicaid.
• Updating and maintaining MD Staff with the progress of all activities.
• Complete facility payer enrollment paperwork for providers and return to the facility in a timely manner.
• Manage Availity portal for various insurance networks.

Skills

Payer Enrollment

Credentialing software

Communication

Tools

MD Staff

CAQH

PECOS

NPPES

Availity

Job description

TeleSpecialists is transforming healthcare delivery as the nation's largest and fastest-growing digital healthcare leader. By providing expert neurological and psychiatric care directly to over 400 hospitals and health systems across the country, we don't just provide care; we pioneer solutions that make quality healthcare easily accessible.

Join a team where your passion meets our purpose. If you’re inspired by innovation, thrive in a collaborative and entrepreneurial environment, and want to be a part of a team that’s reshaping the future of patient care, we want you on our team. At TeleSpecialists, you'll discover more than just a job. You will be able to experience meaningful work, accelerated career growth, and the opportunity to redefine healthcare for the future.

Tele Specialists Offers:

• A great culture with a team environment
• A fun, diverse work environment
• A rapidly growing company with career advancement opportunities
• Medical, Dental and Vision benefits
• Tuition Reimbursement
• Paid Vacation
• Leadership Training Classes

About the Role:

The Payer Enrollment Team Member is responsible for assisting facilities with enrolling TeleSpecialists providers with Medicare, state Medicaid and commercial insurance carriers. The Payer Enrollment Team Member is responsible for maintaining current CAQH, PECOS and State Medicaid profiles. The Payer Enrollment Team Member also ensures that management is made aware of any issues with the provider profiles.

Essential Duties and Responsibilities:

• Complete initial, reassignment and re-validation applications with Medicare for facilities and providers.
• Complete initial, reassignment and re-validation applications with various state Medicaid’s for facilities and providers.
• Ensure physician Medicare re-validation apps for Commercial insurance networks are completed on time.
• Maintain PECOS portal for providers, including approval of facilities and updating demographic information.
• Manage and Maintain NPPES portal for providers.
• Create, update, and maintain CAQH profiles for providers.
• Manage Practice Manager CAQH profile for all providers and facilities.
• Manage password updates for various enrollment portals, included but not limited to CAQH, Medicare and Medicaid.
• Updating and maintaining MD Staff with the progress of all activities.
• Complete facility payer enrollment paperwork for providers and return to the facility in a timely manner.
• Manage Availity portal for various insurance networks.

Qualifications / Experience:

• Payer Enrollment experience required.
• Credentialing software experience required; MD Staff preferred.
• Experience with Joint Commission or National Committee for Quality Assurance preferred.

Travel Requirements (if applicable):

Other Duties:

This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Duties, responsibilities, and activities may change or be assigned at any time based on business needs.

Physical Requirements:

• Must be able to remain in a stationary position (sitting or standing) for prolonged periods, often up to 75% of the workday.
• Needs to occasionally move about inside the office to access file cabinets, office machinery, or shared workspaces.
• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and printer.
• Must be able to exchange accurate information with clients and co-workers in person, over the phone, and via digital platforms.
• Occasionally moves or transports office supplies, files, or equipment weighing up to 25 pounds.
• Occasionally positions self to maintain files in cabinets or access equipment stored in low or high areas.
• Requires close visual acuity to perform activities such as preparing and analyzing data, transcribing, and viewing a computer monitor for extended periods.

Equal Employment Opportunity & ADA Statement

The Company is an equal opportunity employer and is committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law. The Company will provide reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws.