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Provider enrollment specialist skills for your resume and career

Updated January 8, 2025
4 min read
Quoted expert
Elisha Blankson
Provider enrollment specialist example skills
Below we've compiled a list of the most critical provider enrollment specialist skills. We ranked the top skills for provider enrollment specialists based on the percentage of resumes they appeared on. For example, 12.4% of provider enrollment specialist resumes contained data entry as a skill. Continue reading to find out what skills a provider enrollment specialist needs to be successful in the workplace.

15 provider enrollment specialist skills for your resume and career

1. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how provider enrollment specialists use data entry:
  • Initiated data entry of provider-related demographic information changes and overseen testing and completion of change requests for the network.
  • Prepared correspondence reports and performed data entry on all incoming correspondence mail.

2. Patients

Here's how provider enrollment specialists use patients:
  • Handle confidential or sensitive information with discretion pertaining to all Providers and Medicare patients.
  • Communicated via telephone and written correspondence with insurance companies, patients and physicians.

3. CAQH

Here's how provider enrollment specialists use caqh:
  • Submitted Texas Standardized Credentialing Applications for all providers not in the CAQH data base (Council for Affordable Quality HealthCare).
  • Screen and enroll providers in Medicare, Medicaid, Blue Cross, CAQH and other health plans.

4. Medicare

Medicare is a federal government insurance program that offers health care coverage to people who are 65 and above. In some cases, younger people with disabilities whose status is identified by the SSA can also avail the insurance program. Medicare covers the health expenses of people who are not able to afford it plus it protects the payee from rising health care costs.

Here's how provider enrollment specialists use medicare:
  • Processed Medicare applications for physicians/non-physicians.
  • Reviewed provider enrollment applications to ensure the credentials and licenses met all requirements for participation in the Medicare program.

5. Medicaid

Here's how provider enrollment specialists use medicaid:
  • Examined, analyzed and interpreted a high volume of provider information to determine eligibility for acceptance as a Medicaid enrolled provider.
  • Verify information, research application details, and make decisions on provider enrollment applications based on the Georgia Medicaid program guidelines.

6. Provider Enrollment Applications

Here's how provider enrollment specialists use provider enrollment applications:
  • Processed provider enrollment applications for CMS utilizing outlined guidelines within the Federal and State Programs regional requirements.
  • Manage the completion and submission of provider enrollment applications in accordance with established guidelines and procedures.

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7. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how provider enrollment specialists use cms:
  • Conducted outbound enrollment verification calls according to CMS requirements.
  • Validated provider enrollment data according to CMS guidelines.

8. HIPAA

Here's how provider enrollment specialists use hipaa:
  • Retained records related to completed provider enrollments and understood and adhered to HIPAA Privacy & Security policies and procedures.
  • Documented communication meticulously and maintained confidentiality per HIPAA laws.

9. Provider Enrollment

Here's how provider enrollment specialists use provider enrollment:
  • Ensured all Provider Enrollment Specialists understand program goals/requirements, identify performance issues and determine appropriate course of action for performance improvement.
  • Responded to provider enrollment telephone and written inquiries, by establishing a positive rapport and presenting a favorable corporate image.

10. Medicare Program

Here's how provider enrollment specialists use medicare program:
  • Gather any additional information to assist the provider or organization with enrollment into the Medicare program.
  • Possess extensive knowledge of the processing systems, reports and forms used to administer the Medicare Program.

11. Insurance Carriers

Here's how provider enrollment specialists use insurance carriers:
  • Scan and fax documents to provider folder Enrollment with insurance carriers Provide current credentials and update database as necessary
  • Coordinated with government and commercial insurance carriers to maintain most current application and processes for enrollment.

12. DEA

Drug enforcement agents are specialized law enforcement officers, deployed to fight crime, especially drug-related offenses like the purchase and sale of illegal drugs. DE agents are physically fit and trained with the proper understanding of the law, training, and education.

Here's how provider enrollment specialists use dea:
  • Verify Tax ID, DEA, Provider credentials, Liability Insurance along with other documentation for enrollment.
  • Researched providers using several websites including DEA, state licensing board, and NPPES.

13. Quality Standards

Quality standards are a specific level of standards of products that are set by the companies for the customers that have to be met and maintained throughout the process until the time of delivery. Quality standards are information that includes the customer's requirements, guidelines, and characteristics for the needed final product or service.

Here's how provider enrollment specialists use quality standards:
  • Monitored departmental quality standards and implemented policies and programs to ensure standards were met continually.
  • Mentor and provide coaching support to the inquiry team within established quality standards and best practices.

14. NPI

Here's how provider enrollment specialists use npi:
  • Conducted outbound calls to providers to validate NPI and associated provider information for the conversion from software system to mainframe.
  • Utilized the National Plan & Provider Enumeration system prior to provider setup to ensure validity of NPI and taxonomy.

15. Provider Credentials

Here's how provider enrollment specialists use provider credentials:
  • Verified and entered provider credentials and board certification status in accordance with state and federal guidelines.
  • Maintain provider credentials, input information into Provider relations.
top-skills

What skills help Provider Enrollment Specialists find jobs?

Tell us what job you are looking for, we’ll show you what skills employers want.

What type of skills will young provider enrollment specialists need?

Elisha BlanksonElisha Blankson LinkedIn profile

Program Director NCCU, Assistant Professor, North Carolina Central University

Graduates will need a skill set about the field in which they received training and additional skills useful to the job market. For example, with the changing demographics in the United States, extra skills in information technology and foreign languages will be a plus when entering the job market.
Do you want to know more?
Read more about what experts have to say about provider enrollment specialist

List of provider enrollment specialist skills to add to your resume

Provider enrollment specialist skills

The most important skills for a provider enrollment specialist resume and required skills for a provider enrollment specialist to have include:

  • Data Entry
  • Patients
  • CAQH
  • Medicare
  • Medicaid
  • Provider Enrollment Applications
  • CMS
  • HIPAA
  • Provider Enrollment
  • Medicare Program
  • Insurance Carriers
  • DEA
  • Quality Standards
  • NPI
  • Provider Credentials
  • Provider Numbers
  • Claims Processing
  • Tricare
  • Cactus
  • Provider Data
  • CPT
  • Provider Inquiries
  • Process Applications
  • Board Certification
  • MC
  • EFT
  • Care Organizations
  • OIG
  • Inbound Calls
  • Malpractice Insurance
  • EDI
  • Hippa
  • Government Agencies
  • Outbound Calls
  • Provider Contracts
  • Technical Assistance
  • BCBS
  • Background Checks
  • Medical Claims
  • ICD-9
  • Provider Community
  • Main Liaison

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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