Job Details

Job Purpose
The Provider Enrollment Associate is responsible for credentialing/enrolling new and established health care providers and maintenance of required information.

Duties and Responsibilities

Communicates with providers to explain process and sign applications

Collects, updates, maintains necessary provider information and documentation and verifies the information where possible

Establishes and maintains data entry in CAQH

Prepares provider enrollment applications for all initial applications and re-credentialing in a timely and complete manner

Verifies provider and group information with insurance companies (addresses, contracted plans, provider ID numbers, etc.)

Coordinates information for enrollment and termination of all providers

Handles enrollment with Medicare, Medicaid, commercial insurances

Contributes to the departmental process and procedures with a collaborative approach

Works department client WQ's and smart feeds where applicable

Maintains provider enrollment mailbox and completes actions and follow up

Performs other duties as requested

Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Understand and comply with Information Security and HIPAA policies and procedures at all times

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

High School graduate or equivalent required

Minimum two years of provider enrollment experience

Knowledge of Microsoft Office Suite, Outlook, Excel, CAQH

Billing knowledge and experience preferred

Excellent verbal and written communication skills

Strong interpersonal skills, ability to communicate well at all levels of the organization

Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

High level of integrity and dependability with a strong sense of urgency and results oriented

Excellent written and verbal communication skills required

Gracious and welcoming personality for customer service interaction

Working Conditions

Must possess a smart‑phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.

Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non‑merit based factors, or any other characteristic protected by federal, state or local law.

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