Certified Provider Enrollment Specialist

Job Summary

Managing the end-to-end enrollment lifecycle for federal and managed care plans, the full-time remote Certified Provider Enrollment Specialist will execute enrollment functions, maintain accurate clinic data, and serve as a technical resource for health plan oversight representatives.

Key responsibilities:

• Execute core duties of the enrollment lifecycle, including contract initiation and maintenance of billing privileges
• Manage updated group practice location information in the enrollment database and lead delegation oversight reviews
• Create complex ad-hoc reports and rosters to meet health plan data requests and ensure compliance with NCQA standards

Required qualifications:

• High School diploma or G.E.D. required
• At least 3 years of experience in provider enrollment, health plan administration, or medical staff services
• Certified Provider Enrollment Specialist (CPES) or Certified Provider Credentialing Specialist (CPCS) required, or to be obtained within 12 months of hire
• Advanced knowledge of NCQA accreditation standards and the regulatory environment governing provider enrollment
• Mastery of healthcare-specific database functionality for creating complex rosters and custom data extracts