Provider Enrollment Specialist

Job Summary

Support the enrollment process by reviewing, researching, analyzing, and processing provider applications. This role ensures provider file accuracy and compliance with established standards and guidelines.

Key Responsibilities

Review and validate medical provider enrollment applications (initial, re-enrollment, reactivation, or updates)
Verify provider data via internal databases and external agencies; set up and test EFT accounts
Enter and update provider information in enrollment databases and directories
Communicate with providers, agencies, and internal departments to resolve discrepancies
Supply application materials and process guidance to potential enrollees
Assist with special projects, process improvements, provider education, and system testing
Participate in growth and development opportunities within the role

Minimum Qualifications

Work Experience

CMS 855 application management experience
PECOS utilization experience
Customer service representative (CSR) experience
Previous provider enrollment experience for Medicare

Education

High school diploma or equivalent required
Associate's or Bachelor's degree preferred

Skills and Abilities

Proficiency with word processing
Strong judgment, organization, and customer service skills
Clear verbal and written communication
Solid grammar, spelling, and punctuation skills
Basic business math competency
Analytical and critical thinking ability
Discretion in handling confidential information

Software and Tools

Microsoft Office