Provider Enrollment Specialist

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Job Overview

The Provider Enrollment Specialist position at GoHealth Urgent Care is a critical role focused on managing and overseeing the provider enrollment process across various payers and states. This position requires ensuring that enrollment data is both accurate and that it remains current within the company's internal systems. As part of the revenue cycle team, the Specialist will actively identify and address any claim issues related to provider enrollment to ensure smooth operations.

Key Responsibilities

The main responsibilities of the Provider Enrollment Specialist include:

• Tracking provider enrollment status: The Specialist must keep a close watch on the enrollment status with different payers, including Medicare, Medicaid, and commercial insurers.

• Maintaining accurate records: It is essential to have precise and updated records of provider enrollment status and credentials in both internal and external systems.

• Liaison role: The Specialist acts as the intermediary between providers, team members, joint venture partners, and payers to resolve any enrollment and credentialing issues.

• Investigating claim denials: The individual will need to investigate and resolve any claim rejections and denials that arise due to enrollment discrepancies.

• Collaboration: The Specialist collaborates with the enrollment submission team to receive updates and clarify enrollment timelines, as well as with the billing team to ensure timely claims submission.

• Compliance assurance: Ensuring compliance with both state and federal regulations, as well as specific guidelines from payers, is crucial in this role.

• Documenting enrollment progress: Assisting with documentation and reporting for both internal and external audits is expected.

Qualifications

Required Skills & Experience

To qualify for the position, candidates must meet the following requirements:

• Education: A High School Diploma or GED is required; an Associate's degree is preferred.

• Work Experience: At least 2 years of experience in healthcare, customer service, or a role with similar responsibilities is essential.

Preferred Knowledge

• Familiarity with electronic Medical Record systems such as EPIC and EClinical Works.
• Strong understanding of Medicare, Medicaid, and commercial payer enrollment processes.
• Proficiency in the Microsoft Office Suite, especially Excel and Word, for data tracking.
• Excellent written and verbal communication abilities, which are important for working collaboratively with various stakeholders including providers and insurance payers.
• Ability to handle sensitive personal identifying information in compliance with HIPAA standards.
• Skills in identifying trends and recommending improvements in enrollment and claims processes.

Personal Attributes

The role requires several personal attributes for success:

• Attention to Detail: A strong focus on maintaining accurate records and tracking enrollment status is vital.
• Interpersonal Skills: The ability to build relationships across departments and collaborate effectively is necessary.
• Problem-Solving Skills: The Specialist should be able to address and resolve issues creatively and proactively.
• Adaptability: Comfort in a fast-paced environment where priorities may shift frequently is crucial.

Employment Structure

This role is a full-time position, located in the United States. GoHealth Urgent Care demonstrates a commitment to diversity, inclusion, and professional growth within the workplace. The company promotes core values such as collaboration, innovation, and accountability, which are integrated into the responsibilities of the Provider Enrollment Specialist.

Physical Requirements

The position may entail tasks performed in a climate-controlled office environment and may require the ability to lift or carry materials weighing up to 10 lbs. Frequent changes in position between sitting, standing, and walking may also be part of the daily requirements. Some travel may be necessary between company locations or for out-of-town tasks.

Compensation

While specific salary details were not provided in the listing, the role is situated in a high-demand healthcare sector where competitive compensation packages are often structured around industry standards and the level of experience of the candidate.

Final Thoughts

For those seeking employment in the healthcare sector with a passion for provider relations and enrollment management, this role at GoHealth Urgent Care offers a rewarding opportunity to engage with both internal teams and external partners. Individuals interested in contributing positively to healthcare services while ensuring compliance for better patient outcomes will find this position fulfilling. Prospective candidates should be prepared to showcase their qualifications in a professional format during the application process, highlighting relevant experience and skills that align with the job responsibilities.

This job offer was originally published on himalayas.app