Provider Enrollment Specialist

Provider Enrollment Specialist - West Norriton PA Monday to Friday 8:00 AM to 5:00 PM

Pay range: $60500 per year

Salary offers are based on a wide range of factors including relevant skills training experience education and where applicable certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

Benefits information:
We are proud to offer best-in-class benefits and programs to support employees and their families in living healthy happy lives. Our pay and benefit plans have been designed to promote employee health in all respects physical financial and developmental. Depending on whether it is a part-time or full-time position some of the benefits offered may include:

• Day 1 Medical supplemental health dental & vision for FT employees who work 30 hours
• Best-in-class well-being programs
• Annual no-cost health assessment program Blueprint for Wellness
• healthyMINDS mental health program
• Vacation and Health/Flex Time
• 6 Holidays plus 1 MyDay off
• FinFit financial coaching and services
• 401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
• Employee stock purchase plan
• Life and disability insurance plus buy-up option
• Flexible Spending Accounts
• Annual incentive plans
• Matching gifts program
• Education assistance through MyQuest for Education
• Career advancement opportunities
• and so much more!

Manage monitor and complete activities related to Provider Enrollment applications revalidation updates and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) Department of Health (DOH) for Medicare Medicaid and Health Plan payers for Quest Diagnostics its subsidiaries joint ventures and their respective testing facilities. Drive process compliance controls and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.

• Review prepare and submit requests for Medicare Medicaid and Health Plan payers to include completion of but not limitedto:provider enrollment applications revalidation requests NPI enrollments licensure updates CAQH physician credentialing health plan credentialing attestations and disclosures of ownership
• Engage with stakeholders such as Health Plans Legal Business Development Compliance Laboratory Operations and Optum to successfully complete enrollment requests and related activities
• Engage with payers directly to discuss enrollment issues inquiries updates and due dates of enrollment applications
• Review and monitor credentialing reports of enrolled physicians facilities and provider groups to proactively submit credentialing applications in advance of payer-defined enrollment/re-enrollment deadlines.
• Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
• Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and the DocuSign eSignature tool.
• Accurately and efficiently submit enrollment and credentialing applications
• Effectively manage and update status of enrollments by way of case creation and management
• Effectively communicate with agencies health plans and internalstakeholderson status of enrollments and credentialing applications

Required WorkExperience:

• 3 years relevant experience including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
• Relevant experience in large complex organizations commerciallabs or healthcare organizations

Skills:

• Strong analytical and problem-solving skills
• Strong interpersonalskills;ability to work with external clients and multiple levels internal
• Ability to handle confidential or sensitive information with discretion
• Strong written & verbal communication
• Strong attention to detail
• Strong technical skills in MS Word and Excel
• Able to multi-task and perform in a fast-paced environment
• LomingersCompetencies:
• Customer Focus
• Organizational Savvy
• Learning on the Fly
• Problem Solving
• Dealing with Ambiguity
• Drive for Results

Education

• Bachelors Degree (Preferred)

Competencies

• Action oriented
• Business acumen
• Customer Focused
• Interpersonal savvy
• Organizing
• Priority Setting
• Time management