Provider Enrollment Specialist - CAP

Cayugahealth; Town of Ithaca (NY); Hybrid; USD 34,000 - 45,000; Full time

Job summary

Cayuga Health in Ithaca, NY is seeking a Provider Enrollment Specialist to maintain provider data and enrollment for CHP and Centralus Health networks. You will build relationships with practices, payers, and CHP participants to ensure timely enrollment and revalidation.

The role requires an Associate's degree and 2–5 years of enrollment/credentialing experience, with a hybrid schedule (1–2 days in-office in Ithaca) and a pay range of $25–$33 per hour plus benefits.

Qualifications

• Associate's degree required.
• 2–5 years of provider enrollment or credentialing experience.
• IPA / Medical Group / Hospital experience or healthcare operations experience preferred.

Responsibilities

• Perform provider enrollment activities and submit enrollment applications.
• Review enrollment documents for completeness (licensure, liability, DEA).
• Follow up with physicians for missing information to complete enrollment.
• Maintain provider data in the Provider Data Management System.
• Communicate with health plans to maintain provider rosters.
• Notify CHP staff of contract terminations and provider reassignment.
• Support network initiatives with accurate provider rosters.

Skills

Provider enrollment

Credentialing

Healthcare operations

Communication skills

Education

Associate's degree

Job description

**About Cayuga Health** Cayuga Health offers patient-centered, comprehensive health services at Cayuga Medical Center in Ithaca; Schuyler Hospital in Montour Falls; and more than 40 medical offices in the Finger Lakes and Central New York. Cayuga Health employs more than 450 providers from 40+ specialties. Additional services include a neo-natal intensive care unit, a home health care agency, an addiction recovery organization, and a skilled nursing facility.Cayuga Health is a member of Centralus Health, a community-based integrated delivery system. Our mission is to deliver high-quality care, empower our teams to succeed, and improve the wellbeing of the communities we serve.Our commitment to quality personalized care begins with our exceptional team—over 6500 employees strong. At Cayuga Health, you will work in a collaborative environment that values excellence, integrity, compassion and stewardship. Together, we create an environment where empathy, honesty and a dedication to quality thrive, empowering us to make a positive impact on the lives we touch.We offer competitive wages, comprehensive benefits, and professional development opportunities to help our employees grow and thrive. Whether you are just starting your career or taking the next step in healthcare, we invite you to join us in shaping the future of care in our communities.Learn more at www.cayugahealth.org.***Summary:*** The Provider Enrollment Specialist is primarily responsible for the initial and ongoing maintenance of provider and organization data entry and enrollment needed to support multiple functions within the Cayuga Health Partners Network and Centralus Health. This position will be responsible for completing provider enrollment applications according to internal policies, health plan policies, and other regulatory agencies such as NCQA, CMS, and NYS Department of Health, ensuring continued Network compliance. This position acts as a liaison between our Network, CHP providers and practices, and health plans. The Provider Enrollment Specialist will build and maintain professional relationships with Practice billing and credentialing staff, payer-provider representatives, and providers. ***Roles and Responsibilities:**** Perform provider enrollment activities as necessary.* Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications. Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations.* Review and assess for completeness of information of enrollment documents, including current state licensure, liability insurance, DEA, etc.* Responsible for follow-up with physicians and providers on missing information needed to complete payer enrollment.* Responsible for the generating, mailing, tracking, and subsequent processing of provider revalidation applications. Interacts with representatives from health plans in an effort to resolve any delays in approvals as well as CHP Participants to answer inquiries and clarify requirements.* Update Provider Data Management System when new information is received.* Responsible for working with health plans on a routine basis to maintain their Provider Rosters.* Responsible for notification to health plan and applicable CHP participants. Notification includes date of contract termination, anticipated health plan termination (if different than contract termination) and provider for membership re-assignment.\\** Maintain a current and accurate Provider Roster, communicating provider changes to appropriate CHP staff to support Network Initiatives.* Maintains extensive working knowledge of provider enrollment.\\** Is flexible in assuming other appropriate responsibilities not noted above. ***Required Skills and Experience:**** Education - Associate's degree* Experience - Two to five (2-5) years of experience, including previous provider enrollment or credentialing experience with IPA / Medical Group / Hospital experience or healthcare operations experience (i.e. claims processing, billing, provider relations or contracting)* Licensure - None required ***Preferred Skills and Experience:**** Notary Public certification**Physical Requirements*** 90% sitting; 10% standing* Must be able to remain at a workstation and move around the workspace as needed to complete job tasks, with or without reasonable accommodation. This position may require occasional driving to practice locations.* The person in this position frequently communicates with Practices and Providers. Must be able to exchange accurate information in these situations.***Location, Travel and Shift Requirements:**** Hybrid position available. Preferred one to two days per week in the office as needed in Ithaca, NY. ***Pay Range Disclosure:**** Standard Rate of $25.00 - $33.00 per hour plus benefits