• Should have a minimum of 2 to 3 years experience
• Extensive experience in the health care or managed care industry is an absolute requirement
• Ability to work under minimum supervision and demonstrate strong initiative
• Ability to recognize, evaluate, solve problems, and correct errors, and to develop processes that eliminate redundancy
• Ability to conceptualize workflow, develop plans, and implement appropriate actions
• Ability to communicate effectively in writing, over the telephone, and in-person
• Skill in establishing and maintaining effective working relationships with other employees, middle and senior management in the organization
• Proficient in Microsoft Office, including Outlook, PPT, Word, and Excel
• Should be flexible to work in night shifts
• Onboarding incoming physicians and allied health professionals by performing efficient and thorough verification of professional credentials.
• Efficient, error-free enrollment in all insurance carrier plans including Medicare, Medicaid, private insurance plans, workers compensation plans.
• Initiating and maintaining hospital privileges and responding to all correspondence related to maintaining privileges, licensure efficiently with a minimal lapse in time.
• Ensuring that all licenses, certification, malpractice insurance, and enrollment statuses of all providers remain active. Timely completion of revalidation applications.
• Enrollment Specialist must be able to work with all Licensing Agencies to complete facility licensure applications including DME, CLIA Enrollment.
• Thorough knowledge of CAQH, FCVS, NPPES, PECOS, NPDB AVAILTY, NAVINET, and internet-based provider enrollment with all insurance companies.
• Coordinate and maintain a tracking database for provider contracts and re-validation, re-credentialing, and enrollment applications and correspondence.