Provider Enrollment Specialist

Job Summary

Support the enrollment process by reviewing, researching, analyzing, and processing provider applications. This role ensures provider file accuracy and compliance with established standards and guidelines.

Key Responsibilities

• Review and validate medical provider enrollment applications (initial, re-enrollment, reactivation, or updates)
• Verify provider data via internal databases and external agencies; set up and test EFT accounts
• Enter and update provider information in enrollment databases and directories
• Communicate with providers, agencies, and internal departments to resolve discrepancies
• Supply application materials and process guidance to potential enrollees
• Assist with special projects, process improvements, provider education, and system testing
• Participate in growth and development opportunities within the role

Minimum Qualifications

Work Experience

• CMS 855 application management experience
• PECOS utilization experience
• Customer service representative (CSR) experience
• Previous provider enrollment experience for Medicare

Education

• High school diploma or equivalent required
• Associate's or Bachelor's degree preferred

Skills and Abilities

• Proficiency with word processing
• Strong judgment, organization, and customer service skills
• Clear verbal and written communication
• Solid grammar, spelling, and punctuation skills
• Basic business math competency
• Analytical and critical thinking ability
• Discretion in handling confidential information

Software and Tools

• Microsoft Office