Provider Enrollment Specialist

QUEST DIAGNOSTICS INC; West Norriton Township (PA); On-site; USD 61,000 - 75,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) with company match

Employee stock purchase plan

Annual incentive plans

Career advancement opportunities

Job summary

Quest Diagnostics is seeking a Provider Enrollment Specialist in West Norriton, PA, Monday to Friday, 8:00 AM to 5:00 PM. This role focuses on managing enrollment applications and credentialing for CMS payers, ensuring accuracy and process standardization.

You will coordinate with health plans, legal, and operations to review enrollment items like NPI, CAQH, attestations, and disclosures, and ensure timely submission via secure portals and DocuSign eSignature tools.

Qualifications

• Bachelor’s degree preferred with relevant healthcare enrollment knowledge.
• 3+ years’ experience with Medicare/Medicaid provider enrollment or health plan enrollments.
• Experience in large, complex organizations, commercial labs, or healthcare settings.
• Ability to handle confidential information with discretion.

Responsibilities

• Review, prepare and submit enrollment requests for Medicare, Medicaid, and health plan payers.
• Engage with Health Plans, Legal, Business Development, Compliance, and Operations to complete enrollment activities.
• Communicate with payers on enrollment issues, inquiries, and due dates.
• Monitor credentialing reports and submit credentialing applications ahead of deadlines.
• Maintain enrollment data in centralized databases and CRM systems.
• Submit enrollment and credentialing applications accurately and efficiently.
• Manage enrollment statuses via case creation and tracking.
• Coordinate with agencies and internal stakeholders on enrollment status.

Skills

Analytical skills

Problem solving

Interpersonal skills

Attention to detail

Verbal & written communication

MS Word

MS Excel

Confidentiality

CRM software

Multi-tasking

Education

Bachelor’s Degree (Preferred)

Job description

Job Description

Provider Enrollment Specialist - West Norriton, PA, Monday to Friday, 8:00 AM to 5:00 PM

Pay range: $60,500+ per year

Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

Benefits information:

• Day 1 Medical, supplemental health, dental & vision for FT employees who work 30+ hours
• Best-in-class well-being programs
• Annual, no-cost health assessment program Blueprint for Wellness®
• healthyMINDS mental health program
• Vacation and Health/Flex Time
• 6 Holidays plus 1 'MyDay' off
• FinFit financial coaching and services
• 401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
• Employee stock purchase plan
• Life and disability insurance, plus buy-up option
• Flexible Spending Accounts
• Annual incentive plans
• Matching gifts program
• Education assistance through MyQuest for Education
• Career advancement opportunities
• and so much more!

Manage, monitor and complete activities related to Provider Enrollment applications, revalidation updates and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers, for Quest, Diagnostics, its subsidiaries, joint ventures and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.

Responsibilities:

• Review, prepare and submit requests for Medicare, Medicaid, and Health Plan payers to include completion of but not limited to:provider enrollment applications, revalidation requests, NPI enrollments, licensure updates, CAQH physician credentialing, health plan credentialing, attestations, and disclosures of ownership
• Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations and Optum to successfully complete enrollment requests and related activities
• Engage with payers directly to discuss enrollment issues, inquiries, updates and due dates of enrollment applications
• Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer-defined enrollment/re-enrollment deadlines.
• Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
• Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and the DocuSign eSignature tool.
• Accurately and efficiently submit enrollment and credentialing applications
• Effectively manage and update status of enrollments by way of case creation and management
• Effectively communicate with agencies, health plans and internalstakeholders’on status of enrollments and credentialing applications

Qualifications:

Required Work Experience:

• 3 + years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
• Relevant experience in large, complex organizations, commerciallabs, or healthcare organizations

Skills:

• Strong analytical and problem-solving skills
• Strong interpersonalskills;ability to work with external clients and multiple levels internal
• Ability to handle confidential or sensitive information with discretion
• Strong written & verbal communication
• Strong attention to detail
• Strong technical skills in MS Word and Excel
• Able to multi-task and perform in a fast-paced environment
• Lominger’sCompetencies:
• Customer Focus
• Organizational Savvy
• Learning on the Fly
• Problem Solving
• Dealing with Ambiguity
• Drive for Results

Education

• Bachelor’s Degree (Preferred)

Competencies

• Action oriented
• Business acumen
• Customer Focused
• Interpersonal savvy
• Organizing
• Priority Setting
• Time management

Quest Diagnostics honors our service members and encourages veterans to apply.

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.