Provider Enrollment Specialist

SCP Health; Lafayette (LA); On-site; USD 18,000 - 26,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan with company match

Paid time off and holidays

Professional development support

Job summary

SCP Health in Lafayette, LA seeks a Provider Enrollment/Payor Credentialing Specialist to process and maintain provider enrollments with Medicare, Medicaid, BCBS and Commercial payors. You will manage multiple submissions, update CAQH data, and ensure credentials are current, acting as the main liaison with payors.

The role requires 3+ years in credentialing, knowledge of CAQH/NPPES, CMS rules, and proficient MS Office skills. On-site work at client facilities may be required.

Qualifications

• Work independently utilizing documented processes and automated daily reports generated from database.
• Analyze and compare processes when payor requirements change to propose solutions.
• Manage multiple priorities with strong organizational and time management skills.
• Knowledge of Payor Credentialing processes (Par and Non-Par).
• Knowledge of Provider Credentials and CAQH/NPPES databases.
• Experience with CMS Regulations and guidelines.
• Proficient in Microsoft Office (Word, Excel).
• Strong communication and collaboration abilities.
• Minimum 3 years of Provider Enrollment/Payor Credentialing experience.

Responsibilities

• Process and maintain provider enrollment for Medicare/Medicaid/BCBS/Commercial payors.
• Prioritize and manage multiple enrollments in a deadline-driven environment.
• Update CAQH database information and provider credentials every 90 days.
• Serve as primary contact for providers and payors on enrollment inquiries.
• Document approvals and effective dates in enrollment systems.
• Perform data entry and follow-up on submissions to ensure timely approvals.
• Maintain confidentiality of privileged information.

Skills

Independent work

Process improvement

Organizational skills

CAQH knowledge

Provider credentials

CAQH/NPI databases

CMS regulations

MS Office (Word/Excel)

Team collaboration

Effective communication

3+ years experience

Education

HS Diploma

Healthcare Administration

Business Administration

PESC

CPCS

Tools

Availity

Credentialing software

Enrollment software

Job description

At SCP Health, what you do matters. As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

• Strong track record of providing excellent work/life balance.
• Comprehensive benefits package and competitive compensation.
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

Primary Duties and Responsibilities:

Process and maintain provider applications for enrollment and re-enrollment for Medicare, Medicaid, BCBS and/or Commercial payors in accordance with Federal and State guidelines.

Prioritize and manage multiple enrollments in a deadline-driven environment.

Distribute, log, receive and scan Provider Enrollment Packets as assigned.

Update National Provider Database information as needed.

Monitor credentials, i.e. Medical License, DEA to ensure they are active and in good standing.

Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.

Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.

Identify any issues with providers eligibility to participate in Government plans.

Advise Supervisor/Manager immediately of any eligibility issues for providers.

Procure all documents needed from Provider to enroll timely.

Escalate to MSL on non-response providers.

Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.

Perform follow up on submissions via online, email or phone according to policies and procedures to ensure timely approval is received.

Maintain accurate database information and perform data quality cleanup activities as directed by Management.

Maintain confidentiality of privileged information.

Work in CAQH database and maintain/update providers’ credentials every 90 days.

On occasion, may be required to be onsite at client facility to distribute PEPs and help facilitate in person enrollment.

Once approval is received from payors, document approval and effective dates in Provider Enrollment system to ensure approvals and information are pushed to Billing System for release of claims.

Monitor changes to payor requirements through payor websites, bulletins, emails, etc and communicate any changes to appropriate Managers to ensure changes are made wherever applicable.

Required Skills and Qualifications:

• Work independently utilizing documented processes and automated daily reports generated from database.
• When payor requirements change, must be able to analyze and compare processes in order to recommend process solutions to Management.
• Agility in managing multiple priorities with strong organizational and time management skills.
• Knowledge of Payor Credentialing processes, both Par and Non-Par.
• Knowledge of Provider Credentials.
• Experience working in CAQH database and National Provider Identifier database.
• Knowledge of CMS Regulations and guidelines.
• Proficient in Microsoft Office applications including Word and Excel.
• Ability to foster a cooperative and respectful work environment.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Ability to communicate effectively both orally and in writing.
• Minimum 3 years of Provider Enrollment/Payor Credentialing experience required.

Preferred Skills and Qualifications:

• Experience with Availity and other provider related credentialing/enrollment databases.
• Experience working with Medicare, Medicaid or any Commercial payor.
• Experience working with Credentialing/Enrollment software.

Education:

HS Diploma required. 2 years college or equivalent experience preferred.

Field of Study:

Healthcare Administration Business Administration

Certificates and Licences:

• Preferred: PESC (Provider Enrollment Specialist Certificate)
• Preferred: CPCS (Certified Provider Credentialing Specialist)

PRIMARY LOCATION: Lafayette, LA

Pay Range: 13.00 - 19.00 USD per hour This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.

• We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.