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Become A Provider Enrollment Specialist

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Working As A Provider Enrollment Specialist

  • Interacting With Computers
  • Getting Information
  • Making Decisions and Solving Problems
  • Updating and Using Relevant Knowledge
  • Communicating with Supervisors, Peers, or Subordinates
  • $48,620

    Average Salary

What Does A Provider Enrollment Specialist Do At Conduent

* Responds to telephone inquiries and complaints using standard scripts and procedures
* Gathers information, researches/resolves inquiries and logs customer calls
* Communicates appropriate options for resolution in a timely manner
* Informs customers about services available and assesses customer needs
* Prepares standard reports to track workload, response time and quality of input
* Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
* People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form.
* For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form

What Does A Provider Enrollment Specialist Do At Randstad

* Manages the interaction with providers and office managers to ensure that all necessary information is collected and analyzed so providers can be credentialed and loaded in the system accurately according to department standards.
* Enters the provider data once the data are validated for accuracy so that providers are paid correctly from the beginning of their affiliation with the Plan.
* Acquires and demonstrates a thorough knowledge of the unique arrangements and ensures the Plan enrolls providers with those arrangements.
* Independently initiates oversight of existing provider record problems.
* Identifies system problems with provider set up and facilitates resolution so that provider payments are accurate.
* Maintains the integrity of Provider Data in Onyx.
* Working hours: 830a
* p

What Does A Provider Enrollment Specialist Do At Highmark Health

* Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
* Handles highly sensitive and confidential information regarding professional providers. (50%)
* Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.
* Maintains positive working relationships with providers.
* Plays an active role in explaining and informing providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes. (15%)
* Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
* Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data. (10%)
* Proactively obtains updated provider credentialing data prior to expiration.
* Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions.
* Completes all additions, updates, and deletions.
* Supports new provider onboarding processes as related to enrollment. (5%)
* Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes.
* Proactively communicated any changes regarding contracting as it relates to enrollment and operations. (5%)
* Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and team work with departments, vendors, etc. (5%)
* Develops databases and spreadsheets for tracking organization providers.
* Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management. (5%)
* Continuously searches for process improvements to achieve accuracy and efficiencies. (5%)
* Performs other duties as assigned or required

What Does A Provider Enrollment Specialist Do At Molina Healthcare

* a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.
* Supports other members of the Provider Services Team when they are in the field.
* Responsible for documenting requests as required in departmental procedures.
* Assists with training of new Provider Services staff members.
* Attends off-site meetings when necessary with medical groups and other providers as needed.
* Complies with required workplace safety standards.
* Job Qualifications
* Required Education
* High School Diploma or equivalent GED
* Required Experience
* year customer service, provider service, or claims experience in a managed care or medical office setting.
* Preferred Education
* Associate's Degree
* Vocational program in Managed Care or some other health care aspect providing a certificate at completion.
* To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
* Molina Healthcare offers a competitive benefits and compensation package.
* Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
* CB
* MHI

What Does A Provider Enrollment Specialist Do At DXC Technology

* Review Enrollment, Revalidation and Change forms.
* Use State regulations to determine provider meets qualification to be enrolled.
* Enter/update provider information in the MMIS system.
* Respond to questions regarding provider eligibility.
* Accurate and timely documenting and response to complex provider inquiries
* Identifies, prioritizes and resolves most questions and issues independently.
* Escalate more complex questions or issues appropriately.
* Complies with contract requirements, business unit rules and related industry and legal regulations.
* DXC Technology is EEO F/M/Protected Veteran/ Individual with

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How To Become A Provider Enrollment Specialist

Because of the wide range of skills used in different computer support jobs, there are many paths into the occupation. A bachelor’s degree is required for some computer support specialist positions, but an associate’s degree or postsecondary classes may be enough for others.

Education

Education requirements for computer support specialists vary. Computer user support specialist jobs require some computer knowledge, but not necessarily a postsecondary degree. Applicants who have taken some computer-related classes are often qualified. For computer network support specialists, many employers accept applicants with an associate’s degree, although some prefer applicants to have a bachelor’s degree.

Large software companies that provide support to business users who buy their products or services often require a bachelor’s degree. Positions that are more technical are likely to require a degree in a field such as computer science, engineering, or information science, but for others, the applicant’s field of study is less important.

To keep up with changes in technology, many computer support specialists continue their education throughout their careers.

Certification

Certification programs are generally offered by vendors or from vendor-neutral certification providers. Certification validates the knowledge of and best practices required by computer support specialists. Companies may require their computer support specialists to hold certifications in the products the companies use.

Advancement

Many computer support specialists advance to other information technology positions, such as network and computer systems administrators and software developers. Some become managers in the computer support services department. Some organizations provide paths for support specialists to move into other parts of the organization, such as sales. For more information, see the profiles on network and computer systems administrators and software developers.

Important Qualities

Customer-service skills. Computer support specialists must be patient and sympathetic. They must often help people who are frustrated with the software or hardware they are trying to use.

Listening skills. Support workers must be able to understand the problems that their customers are describing and know when to ask questions to clarify the situation.

Problem-solving skills. Support workers must identify both simple and complex computer problems, analyze them, and solve them.

Speaking skills. Support workers must describe the solutions to computer problems in a way that a nontechnical person can understand.

Writing skills. Strong writing skills are useful for preparing instructions and email responses for employees and customers, as well as real-time web chat interactions.

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Provider Enrollment Specialist jobs

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Provider Enrollment Specialist Demographics

Gender

  • Female

    78.8%
  • Male

    18.9%
  • Unknown

    2.3%

Ethnicity

  • White

    81.9%
  • Hispanic or Latino

    9.5%
  • Asian

    6.6%
  • Unknown

    1.3%
  • Black or African American

    0.7%
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Languages Spoken

  • Spanish

    59.5%
  • Portuguese

    8.1%
  • Carrier

    8.1%
  • Cornish

    2.7%
  • Dakota

    2.7%
  • French

    2.7%
  • Gujarati

    2.7%
  • Hindi

    2.7%
  • Hmong

    2.7%
  • Polish

    2.7%
  • Lingala

    2.7%
  • Italian

    2.7%
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Provider Enrollment Specialist

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Provider Enrollment Specialist Education

Provider Enrollment Specialist

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Top Skills for A Provider Enrollment Specialist

ProviderEnrollmentApplicationsMedicalProvidersMedicaidProceduresCMSQualityCustomerServiceDataEntryHealthCareProvidersProviderFilesProviderEnrollmentProcessProviderInformationProviderNumbersMedicarePartMCSHealthPlansAdditionalInformationSpecialProjectsInsuranceCompaniesProviderDataCaqh

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Top Provider Enrollment Specialist Skills

  1. Provider Enrollment Applications
  2. Medical Providers
  3. Medicaid
You can check out examples of real life uses of top skills on resumes here:
  • Verify information, research application details, and make decisions on provider enrollment applications based on the Georgia Medicaid program guidelines.
  • Process Medicare enrollment applications for medical providers/practitioners using multiple systems
  • Reviewed, data enter, and process enrollment/update all Medicare/Medicaid related documents.
  • Received calls from providers/members and assisted with claim status, member eligibility, and Georgia Medicaid Policy and Procedures.
  • Conducted outbound enrollment verification calls according to CMS requirements.

Top Provider Enrollment Specialist Employers

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