Provider Enrollment Specialist – Healthcare Networks

Nemours; Jacksonville (FL); On-site; USD 42,000 - 60,000; Full time

Job summary

Nemours seeks a Provider Enrollment Specialist to manage enrollment and re-enrollment for our organization and its healthcare professionals. The role emphasizes accuracy, attention to detail, and adherence to network enrollment processes across managed care payors.

The position involves maintaining electronic enrollment files, handling PHI according to Nemours guidelines, and using systems like ECHO, Excel, PET Tracker, iGuide, Qliksense, and the NPL tracker.

Qualifications

• High School Diploma required.
• Associate Degree preferred.

Responsibilities

• Accurately complete the enrollment/re-enrollment processes for all networks and areas for healthcare providers.
• Maintain detailed provider enrollment files electronically, including scanned documents and PHI handling.
• Maintain internal systems with provider and network participation data (e.g., ECHO, Excel, PET Tracker, iGuide, Qliksense, NPL tracker, Outlook, and Word).
• Perform follow-up with health plans and representatives to expedite participation approval.
• Develop and maintain relationships with Nemours providers, staff, and network representatives to facilitate enrollment/re-enrollment.
• Send enrollment applications to providers to obtain signatures and updated demographic information.
• Collaborate with team members to improve workflows, policies, and cross-train on plan requirements.
• Assist with special priority projects and other duties as assigned.

Education

High School Diploma

Associate Degree (preferred)

Job description

Nemours seeks a Provider Enrollment Specialist to manage enrollment and re-enrollment for our organization and its healthcare professionals. The role emphasizes accuracy, attention to detail, and adherence to network enrollment processes across managed care payors.

The position involves maintaining electronic enrollment files, handling PHI according to Nemours guidelines, and using systems like ECHO, Excel, PET Tracker, iGuide, Qliksense, and the NPL tracker.