Provider Enrollment Associate

Location: Sunrise, FL, United States
Position Overview: 
The Provider Enrollment Associate II is responsible for processing necessary documents to ensure that all physicians are enrolled in government programs and are participating in company approved managed care organizations. This position will also include organizing and maintaining physician files; maintain credentialing reports and update Provider Enrollment Intellicred database; conduct written and oral follow up to determine application status; communicate with all necessary internal departments; develop and maintain relationships with individual contacts for the government agencies as well as managed care organizations; create and maintain blank application files for the government agencies as well as managed care organizations.
Prior Provider Enrollment experience, in a production-driven environment is fundamental for success in this role. The successful individual must also be able to communicate and collaborate effectively with other internal as well as external resources in order to achieve desired results and resolve issues.

  • Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Understanding of medical terminology and protocols
  • Credentialing experience and / or knowledge preferred. Provider Enrollment experience and / or knowledge preferred
  • Critical thinking and compliance to workflows policies and procedures a must.
  • Experience with credentialing systems such as Intellicred, Workview, etc. beneficial
  • Good verbal and written communication experience and skills
  • Good aptitude with learning different systems and navigating between different systems
  • Strong multi-tasking, prioritizing and time management skills
  • Quick ability to adjust to changing and fast pace environment.
  • Excel experience with creating and manipulating spreadsheets
Operational Task and Duties include but not limited to the following:
  • Request and complete all necessary and appropriate forms for submission to the proper healthplan entities
  • Review all applications completed by the Assistant
  • Communicate with healthplans to understand process and use this information to establish and maintain estimated effective dates for providers
  • Prepare check requests for required application fees
  • Maintain and update database with both enrollment status and necessary data elements
  • Document all tasks, phone calls, emails and other forms of communication during the enrollment process in the database
  • Conduct written and oral follow up to determine application status
  • Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary
  • Respond promptly to all questions, received via phone or email, regarding any healthplan and/or group/pin
  • Complete and update CAQH database when appropriate
  • Communicate with all necessary internal departments
  • Scan and index completed applications
  • Develop and maintain relationships with individual contacts for the government agencies as well as managed care organizations
  • Prepare updates upon completion of enrollment and forward with pin and/or group numbers to the Supervisor to review
  • Monitor and update expired licenses, as requested
  • Complete other tasks or projects as assigned
Tami Andrade Fitzpatrick
Senior Recruiter
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