COMMUNITY HEALTH SYSTEMS
Provider Enrollment Spec (Remote)
Franklin
,
Tennessee
Full-time
Job Description
Job Summary
The Provider Enrollment Specialist ensures healthcare providers are properly credentialed and enrolled with payers, government programs, and healthcare networks. This role facilitates accurate and timely submission of applications, maintains compliance with payer requirements, and updates provider records to ensure the organization can bill for services rendered effectively.
Essential Functions
Job Summary
The Provider Enrollment Specialist ensures healthcare providers are properly credentialed and enrolled with payers, government programs, and healthcare networks. This role facilitates accurate and timely submission of applications, maintains compliance with payer requirements, and updates provider records to ensure the organization can bill for services rendered effectively.
Essential Functions
- Prepares, reviews, and submits applications for provider enrollment and re-credentialing with insurance companies, Medicare, Medicaid, and other payers.
- Monitors and tracks enrollment and credentialing statuses, ensuring adherence to deadlines and compliance requirements.
- Updates and maintains accurate provider information in databases, payer systems, and organizational records.
- Communicates with providers, payers, and other stakeholders to resolve enrollment issues and provide updates on application statuses.
- Analyzes payer requirements and ensures applications meet regulatory standards and organizational policies.
- Collaborates with internal teams, including billing and compliance, to address issues impacting revenue cycle management.
- Identifies and implements process improvements to streamline provider enrollment and credentialing workflows.
- Performs other duties as assigned.
- Complies with all policies and standards.
- H.S. Diploma or GED required
- Associate Degree in Healthcare Administration, Business, or a related field preferred
- 2-4 years of experience in provider enrollment, credentialing, or a related role required
- Experience working with healthcare payers, Medicare/Medicaid regulations, and credentialing software preferred
- Strong knowledge of payer enrollment requirements, credentialing standards, and regulatory compliance.
- Proficiency in credentialing software and systems.
- Excellent organizational skills and attention to detail.
- Effective verbal and written communication skills.
- Ability to manage multiple priorities and meet deadlines.
- Certified Provider Credentialing Specialist (CPCS) preferred