Provider Enrollment Specialist

Job Summary

A company is looking for a Provider Enrollment Specialist II to manage enrollment processes for practitioners and facilities in governmental and commercial plans.

Key Responsibilities

• Enrolls providers in commercial and government payor plans, ensuring timely application submissions
• Audits and verifies enrollment documents and maintains accurate PECOS records for hospital outpatient departments
• Monitors provider compliance with enrollment requests and prepares monthly reports for management

Required Qualifications

• High School Diploma or GED required; Bachelor's Degree preferred
• 3 to 5 years of experience in provider enrollment, credentialing, or a healthcare-related setting
• Experience working with Medicaid, Medicare, and commercial payors
• Knowledge of Medicare guidelines for outpatient departments and credentialing standards
• Ability to handle multiple projects and meet deadlines in a fast-paced environment