Provider Enrollment Specialist

Blue Cloud Pediatric Surgery Centers; Nashville (TN); On-site; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a dedicated Provider Enrollment Specialist to join their mission-driven team. This role focuses on facilitating payer enrollment applications and maintaining relationships with insurance representatives, ensuring timely processing and compliance. The ideal candidate will possess strong organizational skills and a keen attention to detail, thriving in a fast-paced environment. With a commitment to providing quality care, this innovative firm offers a supportive workplace and values its employees' contributions. If you are passionate about making a difference in healthcare, this opportunity is perfect for you.

Benefits

Health Insurance

401k Plan with Company Match

Paid Time Off

Flexible Spending Accounts

Disability Coverage

Qualifications

• Knowledge of payer enrollment processes and requirements.
• Strong attention to detail and ability to manage multiple tasks.

Responsibilities

• Facilitate initial and recredentialing payer enrollment applications.
• Ensure applications are complete and submitted on time.

Skills

Provider Enrollment Experience

CAQH

PECOS

Microsoft Office

Credentialing Software

Communication Skills

Organizational Skills

Education

Experience in Provider Enrollment

3+ years of experience

Tools

Microsoft Word

Microsoft Excel

Job description

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About Us

Blue Cloud is the largest pediatric Ambulatory Surgery Center (ASC) company in the country, specializing in dental restorative and exodontia surgery for pediatric and special needs patients delivered under general anesthesia. We are a mission-driven company with an emphasis on providing safe, quality, and accessible care, at reduced costs to families and payors.

NOW HIRING

PROVIDER ENROLLMENT SPECIALIST

About Us

Blue Cloud is the largest pediatric Ambulatory Surgery Center (ASC) company in the country, specializing in dental restorative and exodontia surgery for pediatric and special needs patients delivered under general anesthesia. We are a mission-driven company with an emphasis on providing safe, quality, and accessible care, at reduced costs to families and payors.

OUR VISION & VALUES

At Blue Cloud, it’s our vision to be the leader in safety and quality for

pediatric dental patients treated in a surgery center environment. Our core values drive the decisions of our talented team every day and serve as a guiding direction toward that vision.

• We cheerfully work hard
• We are individually empathetic
• We keep our commitments
  
  

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Facilitate initial and recredentialing payer enrollment applications and credentialing processes for healthcare providers with all relevant insurance payers, including Medicare, Medicaid, and commercial insurers.
• Ensure all applications are complete, accurate, and submitted within specified timeframes.
• Track and update the status of enrollment applications, ensuring timely follow-ups and problem resolution with payers.
• Establish and maintain relationships with payer representatives to track the status of applications and address any issues promptly.
• Conduct regular follow-up with payers to monitor the progress of pending applications and expedite the approval process as needed.
• Document all payer communication and updates within the credentialing system.
• Maintain accurate and up-to-date records of provider information, credentialing status, and payer enrollment details in the credentialing software.
• Track and monitor credentialing expiration dates to ensure timely re-enrollment and avoid interruptions in service or billing.
• Provide updates on enrollment status, metrics, and turnaround times for management review.
• Collaborate with internal teams (such as billing, revenue cycle, and provider relations) to address provider enrollment questions and billing issues.
• Provide guidance and status updates to internal stakeholders as requested.
• Complete and submit EFT agreements with payers to facilitate electronic payments.
• Regularly update provider directories with payers.
• Complete and maintain CAQH profiles for providers, ensuring profiles are accurate and updated.
  
  

Competency

• Knowledge of payer enrollment processes and requirements, EFT processes and CAQH.
• Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.
• Demonstrate accuracy, organizational and problem-solving skills
• Excellent verbal and written communication skills
• Ability to work independently
• Maintains confidentiality
  
  

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

The employee is occasionally required to sit, climb, balance, stoop, kneel, crouch or crawl. The employee must frequently lift and move up to 10 pounds and occasionally lift and move objects up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, start time between 7 am to 9 am.

Travel

No travel is expected for this position.

Required Education And Experience

• Provider Enrollment Experience Preferred
• Experience with CAQH, PECOS and Availity
• Proficient in Microsoft Office – including Microsoft Word & Excel
• Familiar with Internet
• Excellent written and verbal communication skills
• Experience with credentialing software a plus
  
  

Preferred Education And Experience

• Minimum 3 years of experience in Provider Enrollment
  
  

Benefits

• Work with a passionate, dedicated, and talented team in a growing organization committed to doing good
• Health insurance, Flexible Spending and Health Savings Accounts, disability coverage and additional voluntary plans
• 401k plan, including company match
• Paid Time Off
• No on call, no holidays, no weekends
• PayScale: $22-$26/hr
• Remote Opportunity - AZ, ID, TN, MO, TX, MD, CO, FL, PA, SC
  
  

Work Location: Remote (Not eligible for CA employees)

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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