Provider Enrollment Specialist

New Horizon Family Health Services; Greenville (SC); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Annual Leave

Sick leave

Paid holidays

Annual bonuses

Continuing education

Employee discounts

PSLF eligibility

Medical plan

Dental plan

Vision plan

FSA / HSA

Voluntary life insurance

Short/Long-term disability

Accident and critical illness coverage

403(b) retirement plan

Job summary

New Horizon Family Health Services is seeking a Provider Enrollment Specialist to manage enrollment and credentialing processes for physicians and non-physician providers. The role involves coordinating with payers, maintaining databases, and ensuring compliance to prevent payment delays.

The position requires an Associate degree in a related field and at least two years of enrollment/revenue cycle experience, with familiarity of PECOS and SC Healthy Connections portals.

Qualifications

• Associate degree in Healthcare Administration, Business Administration, or related field.
• Minimum of two years’ experience in provider enrollment, revenue cycle management or provider credentialing.
• Knowledge of insurance regulation and compliance; PECOS and SC Healthy Connections portal usage.

Responsibilities

• Greet patients, staff and visitors in a professional manner.
• Coordinate and monitor provider enrollment and re-enrollment with government and commercial plans.
• Maintain provider enrollment databases and track status of applications.
• Prepare and process enrollment applications for Medicare, Medicaid and other payers.
• Ensure timely credentialing information is obtained for enrollment.

Skills

Provider enrollment

Revenue cycle

Regulatory compliance

Education

Associate degree in Healthcare Administration

Tools

PECOS

SC Healthy Connections portal

Job description

This position is responsible for completing all applications for payer plans for purposes of billing and reimbursement for health care services. This includes incorporation of information gathered from the credentialing process. The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial plans.

Duties Performed

• Greets patients, staff and visitors in a pleasant and professional manner.
• Serve as the liaison for troubleshooting any provider or organization enrollment issues.
• Keep the Revenue Cycle Director informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, and plan enrollment to prevent delayed claims filing and disruption to cash flow.
• Develop databases and spreadsheets for tracking the organization’s provider enrollment.
• Accurately maintain all internal systems with appropriate provider and network participation information.
• Complete appropriate steps for updating and maintaining Provider Enrollment Databases to ensure claims are processed timely and accurately.
• Serve as a member of the Revenue Cycle Management Committee.
• Assist other staff in the resolution of provider enrollment issues.
• Complete and review applications for all new providers for assigned organizational contracts with various plans.
• Maintain CAQH profiles for individual providers when granted access by said provider.
• Ensure all work is performed in accordance with established policies and procedures.
• Prepare and process provider enrollment applications and organization enrollment applications for Medicare, Medicaid, and other payers.
• Track and follow-up to obtain provider numbers.
• Build knowledge base for payer requirements and forms.
• Obtain required credentialing paperwork from the HR Department.
• Maintain organized and accurate files for efficient and effective enrollment tracking to ensure credentialing information is obtained for all physician and non-physician providers to be included in enrollment and re-enrollment applications.
• Coordinates delivery of provider applications to appropriate health plans.
• Submit applications to payers.
• Utilize the available portals of various payers as necessary to complete the enrollment process.
• Follow-up and check status of applications with payers until provider and/or organization enrollment is completed.
• Attends all in-service training as required.

Qualifications

• Education: Minimum of an Associate degree in Healthcare Administration, Business Administration, or related field
• Experience: Minimum of two years’ experience in provider enrollment, revenue cycle management or provider credentialing
• Other Requirements: Knowledge of insurance regulation and compliance; Experience with PECOS and the utilization of the SC Healthy Connections portal.

Benefits And Perks

• Automatic:
  • Annual Leave
  • Sick leave
  • Up to 12 Paid Holidays plus your birthday
  • Eligibility for 2 annual bonuses after 1 year of employment when defined eligibility criteria are met
  • Continuing education courses through SC AHEC
  • Various employee discounts. I.e., Verizon, AT&T, YMCA, etc.
  • Eligibility for the Public Service Loan Forgiveness (PSLF) Program
• Optional:
  • Medical (PEBA State Health Plan), Dental and Vision benefits
  • Flexible Spending and Health Savings Accounts
  • Voluntary Life Insurance
  • Short Term Disability and Long Term Disability
  • Accident and Critical Illness Coverage
  • 403 (b) Retirement Plan, with up to 4% employer match after the first year of employment

We are an Equal Opportunity employer.