Provider Enrollment QA Specialist

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia emergency medicine hospital medicine pathology and radiology. Focused on Revenue Cycle Management Ventra partners with private practices hospitals health systems and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues enabling clinicians to focus on providing outstanding care to their patients and communities.

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• As a US Healthcare Provider Enrollment Quality Assurance Specialist you will be responsible for ensuring the accuracy completeness and compliance of provider enrollment processes within a healthcare organization. You will play a critical role in maintaining high standards of quality and efficiency in provider enrollment activities to support the organizations revenue cycle management.

• Quality Assurance Oversight: Conduct thorough reviews and audits of provider enrollment applications documents and data to ensure accuracy completeness and compliance with regulatory requirements payer policies and organizational standards.
• Documentation Verification: Validate and authenticate provider credentials licenses certifications and other required documents submitted during the enrollment process to ensure authenticity and compliance with regulatory and payer requirements.
• Application Processing: Facilitate the timely and accurate processing of provider enrollment applications including data entry verification and submission to relevant regulatory bodies and insurance payers.
• Communication and Collaboration: Collaborate with internal stakeholders such as credentialing teams provider relations billing departments and external parties including providers insurance companies and regulatory agencies to resolve enrollment-related issues discrepancies and inquiries.
• Policy Adherence: Stay updated on changes to healthcare regulations payer enrollment guidelines and industry best practices to ensure compliance and adherence to applicable standards in provider enrollment processes.
• Quality Improvement Initiatives: Identify opportunities for process improvement efficiency enhancement and quality enhancement in provider enrollment workflows. Propose and implement strategies to streamline processes reduce errors and optimize productivity.
• Training and Education: Provide training guidance and support to internal staff involved in provider enrollment activities to ensure understanding of policies procedures and compliance requirements.
• Reporting and Documentation: Maintain accurate records documentation and audit trails of provider enrollment activities. Generate reports analyze data and track key performance indicators to monitor compliance identify trends and support decision-making.

• Bachelors degree in any related field.
• Minimum of 2-3 years of experience in healthcare provider enrollment credentialing or related areas. Experience in quality assurance auditing or compliance roles is highly desirable.

• In-depth understanding of healthcare regulations accreditation standards and payer enrollment requirements (e.g. Medicare Medicaid commercial insurers). Familiarity with enrollment software systems and databases is a plus.
• Strong attention to detail and accuracy in reviewing and verifying provider credentials documents and data.
• Proficiency in data analysis problem-solving and critical thinking to identify discrepancies trends and opportunities for improvement.
• Excellent verbal and written communication skills to effectively communicate with internal and external stakeholders including providers payers and regulatory agencies.
• Ability to manage multiple tasks prioritize workload and meet deadlines in a fast-paced environment.
• Strong interpersonal skills and ability to work collaboratively as part of a team to achieve common goals and objectives.

• Base Compensation will be based on various factors unique to each candidate including geographic location skill set experience qualifications and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates and all qualified applicants will receive consideration for employment without regard to race color ethnicity religion sex age national origin disability sexual orientation gender identity and expression or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities as needed to assist them in performing essential job functions.

Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
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