Provider Enrollment Specialist

United States·Allentownmid

Healthcare ClinicalENT Specialist

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Quick Summary

Requirements Summary

Requires sitting for up to eight hours per day, including extensive use of computer terminal and telephone.

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Healthcare ClinicalENT Specialist

The Provider Enrollment Specialist ensures that initial and re-credentialing applications for St. Luke’s University Health Network (SLUHN) employed providers’ are submitted to identified third party and government health insurance carriers. Responsibilities also include maintaining membership and renewal information for professional and DEA licenses, board certification and professional organization memberships.

Responsibilities

~1 min read

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Prepares provider enrollment applications and/or written link letters to be sent to payers
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Ensures all providers and groups are re-validated with payers on a timely basis by completing re-credentialing applications with current provider information and signatures.
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Makes and receives phone calls from providers and practice managers to help resolve payer issues and verify participating status.
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Updates & maintains database to show enrollment tracking, effective dates, provider numbers and correct provider demographics.
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Scans and files all paperwork and documents to a shared folder for tracking purposes and proof of submission to payers.
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Applies for New Jersey licensure for identified providers.
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Creates and submits new group enrollment applications for newly opened or moving practices. Fields and responds timely to inquiries from SLUHN departments to help resolve enrollment related issues.
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Ensures SLUHN billing department has resolution on enrollment issues that assist with claim processing.
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Identifies and communicates current or potential enrollment issues that could result in loss of revenue and/or patient dissatisfaction.
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Participates in team meetings and conference calls with payers.
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Completes online applications for Doing Business As (DBA) for new or renamed groups.
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Creates check requests for out-of-state enrollment fees.

Requirements

~1 min read

Requires sitting for up to eight hours per day, including extensive use of computer terminal and telephone. Requires hearing as it relates to normal conversation and answering questions in large groups. Requires seeing as it relates to general near and far vision.

High School Education

Experience with personal computers and the Microsoft Office suite of products is required. Strong customer service skills. Excellent verbal and written communication skills. Detail and service oriented.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!