Provider Enrollment Specialist

Northern Light Health Home Office |US:

ME:

Brewer or Remote | Clinical Support | Full Time

Salary range-  USD

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Department:Credentialing

Position is located:Cianchette Professional Blding

Work Type:Full Time

Work Schedule:8:00 AM to 4:30 PM

Exempt:
No

The Provider Enrollment Specialist I is responsible for performing all provider and facility enrollment and re-credentialing activities required of all NLH contracted commercial and governmental payers. The Specialist will support the maintenance of provider CAQH profiles, partner closely with the revenue cycle, follow-up with payers to eliminate risk associated with enrollment gaps, and monitor held claims to ensure timely action. The Specialist will comply with all CVO requirements and adhere to NCQA accreditation standards as outlined in policy.

• Supports and manages the successful completion and timely submission of provider enrollment applications in accordance with payer requirements.
• Partners with department credentialing staff and member hospital leadership when needed to obtain required forms, signatures, and any other required documentation needed for the purpose of enrollment or revalidation.
• Understands specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations.
• Ensures that established provider IDs and enrollment effective dates are updated in the enrollment platform to ensure timely release of claims.
• Actively engages in issue resolution efforts to resolve enrollment rejections, enrollment delays, or troubleshoot denied claims.
• Working knowledge of the following databases: CAQH Proview, PECOS, Availity, MIMHS, and other payer portals required.
• Performs enrollment tracking and timely follow-up to ensure providers are established and linked to the appropriate facility.
• Ensures accurate database management, including provider demographics and enrollment records.
• Acts as a liaison between the Medical Staff and contracted payers.
• Monitors facility enrollment and completes revalidations in accordance with payer requirements and timelines.

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Department:Credentialing

Position is located:Cianchette Professional Blding

Work Type:Full Time

Hours Per Week: 40.00

Work Schedule:8:00 AM to 4:30 PM

Exempt:
No

The Provider Enrollment Specialist I is responsible for performing all provider and facility enrollment and re-credentialing activities required of all NLH contracted commercial and governmental payers. The Specialist will support the maintenance of provider CAQH profiles, partner closely with the revenue cycle, follow-up with payers to eliminate risk associated with enrollment gaps, and monitor held claims to ensure timely action. The Specialist will comply with all CVO requirements and adhere to NCQA accreditation standards as outlined in policy.

• Supports and manages the successful completion and timely submission of provider enrollment applications in accordance with payer requirements.
• Partners with department credentialing staff and member hospital leadership when needed to obtain required forms, signatures, and any other required documentation needed for the purpose of enrollment or revalidation.
• Understands specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations.
• Ensures that established provider IDs and enrollment effective dates are updated in the…