Provider Enrollment Specialist

We have a Provider Enrollment Specialist career opportunity for an experienced professional to join our team at Pediatrix Medical Group.

Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere.
We are confident that you'll love being a part of the Pediatrix team.

The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Provider Enrollment Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates as needed to the appropriate RCM central business offices. The Provider Enrollment Specialist II will assist Management in maintaining provider enrollment goals for all divisions.

• Validates up-to-date plan enrollment forms, completes applications, submits them to plans and follows up until enrollment is complete. Verifies accuracy and coordinates entry of new and revised provider information into Intelli Cred and Master Database.
• Mapping forms in Intelli Cred and prioritizing work, reviewing and researching Health Plan Enrollment requirements at Corporate Business Office.
• Documents assignments in the Credentialing/Provider Enrollment tracking system per the department’s standard operating procedures.
• Contacts health plans to determine enrollment requirements periodically and verify health plan requirements based on the specialty and confirm the most up to date enrollment application forms are readily available in Provider Enrollment Tracking Software (Intelli Cred).
• Prepares/reviews group applications based on information provided during acquisitions, Tax , and Organic Growth Initiatives (OGI).
• Communicates with Business Development, Business Integration and Credentialing to acquire prospective new provider group’s required documents and/or signatures as needed.
• Knowledgeable in reporting system functionality, mapping forms utilizing Provider Enrollment tracking software and IC system Q/A delegate.
• Maintain provider’s profile in PE Tracking system (IC) with up to date with information on active or pending providers by completing all data fields in the Demographics, Appointments and Applications screen for the provider and group practice.
• Maintain provider’s profile in CAQH with up to date with information on active or pending providers by completing all data fields pertaining to demographics, service locations, group entity information, required documents and expirables.
• Monitors all assigned delegated agreement health plan enrollments reports utilized to provide oversight to ensure enrollments currently assigned are being processed timely. i.e.:
  To Do List in IC, Intelli Reports, IC Weekly aging, and IC End of Month.
• Validates status of on boarding provider’s enrollments to ensure Target Start Date is met. Escalates to Provider Enrollment management when necessary in order to meet desired Target Start Date.
• Performs other job-related duties within the job scope as requested by Provider Enrollment Management.

• Associate's degree (A.
  
  A.) or equivalent from two-year college or technical school.
• Three (3) or more years related experience or equivalent combination of education and experience.

• Knowledgeable with Group Entity health plan enrollments, state regulations and appeal processes.
• Knowledgeable in Provider Enrollment policies and procedures and ensuring they are being followed and keeping the loss of revenue from delayed enrollments at a minimum
• Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
• Ability to respond to common inquiries or complaints from customers,…