Enrollment Specialist

Enrollment Specialists are responsible for maintaining the Credentialing portal and filling the gaps in the payer enrollment process at the individual, group, and facility levels.

Responsibilities:

• Acts as a liaison between Deer Oaks’ clinicians and the credentialing partner


• Enrolls clinicians to obtain an NPI number if the clinicians do not have one already


• Assists in creating CAQH ID/Account if needed by the clinicians


• Populates portal with SSN/CAQH ID/Last name to kick off documentation gathering


• Works with the clinicians to gather and upload, missing documentation within the credentialing portal


• Establishes surrogacy relationship with clinicians and the credentialing partner


• Submits requests for enrollment at the individual, group, and facility level for all payers


• Obtains additional documents as needed during enrollment including the facilitation of site inspections if required


• EHR enrollment support (PointClickCare)


• Adds or changes submissions based on new or changed plans and informs the credentialing partner


• Fulfills facility credentialing requests from facilities providing CV, license, COI, etc.


• Updates the clinicians’ taxonomy with NPPES/NPI when needed and communicates changes to the Director


• Updates name changes or records license certification updates


• Tracks collaborative agreements and supervision in the portal


• Executes service location reports for payers, including roster submissions


• Assists with the tracking of CEUs


• Adds and maintains locations and facilities in the portal


• Monitors dashboard to track progress of enrollments and provide any information needed


• Monitors expiration dates and keeps all enrollments, individual or group, active


• Manages Medicaid portals, including linking all places of service to the group when required, and submitting license renewals to maintain Medicaid enrollment.

Qualifications:

High school diploma or equivalent

Associates degree preferred

2 years of relevant healthcare/provider credentialing experience

Experience with full cycle enrollments in Medicare, Medicaid, and Managed Care Plans

Knowledgeable of assigned states credentialing and payer requirements

Experience with state licensure enrollments

Ability to multi-task and prioritize work to meet deadlines

Excellent verbal and written communication skills

Positive customer service attitude

Ability to research and analyze data, and work independently with minimal supervision