Provider Enrollment Specialist, Applications, Remote

Centauri Health Solutions; Tucson (AZ); Remote; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Provider Enrollment Specialist to join their dynamic team. This role focuses on processing Out of State Medicaid claims, managing enrollment applications, and ensuring compliance with payer guidelines. The ideal candidate will possess strong medical administrative experience, critical thinking skills, and a knack for organization. With a commitment to improving health outcomes, this innovative company offers a rewarding work environment, competitive compensation, and a comprehensive benefits package. If you are passionate about making a difference in healthcare, this opportunity is perfect for you.

Benefits

Generous paid time off

Matching 401(k) program

Tuition reimbursement

Annual salary reviews

Comprehensive health plan

Volunteer activities on company time

Development opportunities

Qualifications

• Minimum two years of medical administrative experience required.
• Knowledge of Medicare and Medicaid is essential for this role.

Responsibilities

• Complete training plan and manage assigned task listing effectively.
• Prepare complex hospital and physician enrollment applications.

Skills

Medicare knowledge

Medicaid knowledge

Microsoft Office

Critical thinking

Communication skills

Organizational skills

Education

Medical administrative experience

Credentialing process knowledge

Tools

PDF viewer/application

Job description

Provider Enrollment Specialist, Applications, Remote

Tucson, AZ, USA Req #3335

Thursday, April 24, 2025

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500 list of the fastest-growing companies in the U.S. For more information, visitwww.centaurihs.com.

Role Overview:

Provider Enrollment Specialist is a vital team member with Centauri’s Out of State Medicaid billing agency that works with facilities across the US to process their Out of State Medicaid claims with a focus on hospital billing, hospital and physician enrollment, and eligibility verifications.All team members are assigned tasks and are responsible for ensuring tasks are completed by the assigned follow up date.The position focuses on completing Out of State Medicaid hospital and physician enrollment applications.

Role Responsibilities:

• Complete Training Plan
  • Employees must complete a training plan to master role responsibilities
  • Accounts are audited until training plan is completed in phases
  • Utilize internal user procedures
  • Knowledge of Out of State Medicaid payer guidelines
• Management of assigned task listing
  • Meet daily productivity goals set by Management
  • Review all assigned tasks and complete by the set follow up date
  • Review accounts in a timely manner consistent with identified procedures
  • Prioritize workload based on follow up date, dollar amount, and/or filing limits
  • Document findings and status within the system
  • Identify Payor trends and submit the necessary system updates
  • Upload supporting documentation to the system
  • Work together within assigned groups to determine next steps
  • Utilize multiple systems to prepare enrollment applications and gather the necessary credentials for enrollment
• Enrollment Applications
  • Prepare complex hospital and physician enrollment applications using various provider application formats, including paper forms and/or web portal submission
  • Prepare formal client requests for signatures and credentials according to client specifications
  • Utilize all resources available to obtain credentials and/or information to prepare enrollment forms and updates
  • Verify instructions for new enrollments and updates with Out of State Medicaid payers
  • Responsible for reviewing all client responses to enrollment request to ensure all requested information was received
  • Save new credentials/information when received and update client database. Including but not limited to hospital license, physician license, CLIA, DEA, liability insurance, board certification, proof of instate and/or Medicare enrollment, etc.
  • Research and understand various provider enrollment application formats, discover new information requested and make decisions to complete the tasks required

Role Requirements:

• Minimum two years of medical administrative experience; Medicare and/or Medicaid knowledge. Preferred but not required:
  • Previous experience with all aspects of credentialing process; NPPES, PECOS
  • Knowledge of healthcare provider credentialing and licensure requirements
• Professional and effective decision making, critical thinking, and communication skills with co-workers, clients, and payers; written and oral
• 1 year + including Microsoft Office knowledge
• Drafting letters/formal email requests, preparing documents, and utilizing PDF viewer/application to complete applications according to payer guidelines
• Detail oriented and outstanding organizational skills with the ability to learn new programs and website interface
• Ability to navigate multiple platforms daily
• Proven ability to work independently and as a team member
• Ability to prioritize, organize multiple tasks and remain organized with multiple interruptions

We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities. This position is bonus eligible in accordance with the terms of the Company’s plan.

Centauri currently maintains a policy that requires several in-person and hybrid office workers to be fully vaccinated. New employees in the mentioned categories may require proof of vaccination by their start date. The Company is an equal opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.

Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.

This position is bonus eligible in accordance with the terms of the Company’s plan.