Position Summary

The Senior Enrollment Specialist plays a key role in overseeing the end-to-end payor enrollment process.  This includes managing applications, ensuring compliance with enrollment requirements, and maintaining accurate records and data. As a Senior Specialist this role serves as a primary contact for enrollment inquires and addresses complex enrollment issues, playing a pivotal role in issue resolution.

Job Responsibilities

Complete knowledge and full understanding of the payor enrollment process.
Ability to assess unusual and complex circumstances that may occur with enrollment and uses critical thinking and problem-solving techniques to identify and suggest methods for resolution.
Work is done independently and is reviewed at critical points.
Responsible for overseeing, monitoring, and maintaining the processes involved in both initial and revalidation of payor enrollment applications.
Possess a thorough comprehension of payor enrollment requirements and regulations governing enrollment to ensure ongoing compliance. 
Responsible for securing timely enrollment by submitting applications ahead of deadlines and maintaining consistent follow-up with payors through completion.
Conduct research and document enrollment processes encompassing, but not limited to, initial enrollment, revalidation, and demographic changes.
Regularly update and manage data in the credentialing database, spreadsheets, and folders, while maintaining data integrity.
Assures compliance with payor requirements as related to the provider enrollment and monitor activities to ensure compliance with all procedures and regulations.
Participate in the development and implementation of credentialing processes and procedures and provide input regarding process improvement.
Serve as primary contact for payor inquires and issue resolution, specifically related to enrollment and credentialing matters. 
Assist in the training of colleagues on internal enrollment policies and procedures and provide guidance on navigating payor agencies requirements.
Performs other duties as assigned.
 

Required Qualifications

High school diploma or GED required.
Four to six years of experience in a credentialing office or equivalent related environments.
Knowledge of health plan and governmental payor credentialing process and requirements, such as NCQA/state/federal standards, Medicaid, and Medicare.
Demonstrates proficient communication abilities, both orally and in writing, and strong interpersonal skills.
Exhibits a heightened level of awareness and attention to detail.
Demonstrates outstanding organizational and time management skills.
Demonstrate the ability to work autonomously while effectively contributing to a collaborative team environment.
Ability to maintain confidentiality.
Proficient in Database, MS Excel, Word, Adobe and other software systems.
A team player with multi-tasking capability and strong customer service orientation.
 

Preferred Qualifications

Bachelor’s degree preferred.
Current Certified Provider Credentialing Specialist (CPCS) with the National Association of Medical Staff Services preferred.
Database management skills including querying, reporting, and document generation a plus.
 

Physical Demands

Must possess ability to sit and/or stand for long periods of time.
Must possess ability to perform repetitive motion.
Ability to lift up to 15 pounds.
Majority of work is performed in a desk/cubicle environment.
Required Training

All job specific, safety, and compliance training are assigned based on the job functions associated with this position.
 

Required Training

All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.
 

Other

Travel rarely required.

High school diploma or GED required.
Four to six years of experience in a credentialing office or equivalent related environments.
Knowledge of health plan and governmental payor credentialing process and requirements, such as NCQA/state/federal standards, Medicaid, and Medicare.
Demonstrates proficient communication abilities, both orally and in writing, and strong interpersonal skills.
Exhibits a heightened level of awareness and attention to detail.
Demonstrates outstanding organizational and time management skills.
Demonstrate the ability to work autonomously while effectively contributing to a collaborative team environment.
Ability to maintain confidentiality.
Proficient in Database, MS Excel, Word, Adobe and other software systems.
A team player with multi-tasking capability and strong customer service orientation.