Provider Enrollment Specialist

New York

Rockville Centre, NY | Operations

Position Summary:

The Provider Enrollment Specialist administers the physician and mid-level enrollment applications process for Medicare and Medicaid. The Provider Enrollment Specialist is responsible for preparing and submitting supporting documentation for the purpose of enrolling individual physicians, mid-levels and facilities with Medicare and Medicaid. This position is also responsible for follow up on the status of applications for physician, mid-levels, and facilities, and track the progress on all pending application.

JOB REQUIREMENTS

Education

  • High School Diploma or GED required
  • Bachelor’s Degree preferred

Work Experience

  • Minimum of 2 years’ experience in a larger or similar-sized company required
  • Knowledge of Medicare and Medicaid provider enrollment process
  • Proficiency in Microsoft Office, particularly Word and Excel
  • Professional written and verbal communication and interpersonal skills.

Additional Knowledge, Skills and Abilities Required

  • Proficiency in Microsoft Office, particularly Word and Excel
  • Professional written and verbal communication and interpersonal skills.
  • Ability to participate and facilitate group meetings
  • Ability to effectively communicate with team members, supervisors, JV partners, and insurance contacts
  • Ability to maintain complete confidentiality in handling sensitive enrollment issues.

ESSENTIAL FUNCTIONS

  • Implements the physician enrollment process for physicians and mid-levels with Medicare and Medicaid.
  • Maintain the timelines on enrollment schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
  • Reviews new client packet information to determine any enrollment issues.
  • Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance and state insurance form.
  • Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment.
  • Obtains required client signatures and follows up with the carriers on documentation submitted.
  • Maintains provider information and demographics for all providers.
  • Responds to internal and external inquiries on routine enrollment and contract matters.
  • Monitors and advises clients on enrollment revalidations.
  • Performs other related duties, which may be inclusive, but not listed in the job description

All other duties as assigned.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.

GoHealth Urgent Care invites military veterans to apply for our positions.


GoHealth provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, GoHealth complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.


Keywords:
urgent care, insurance, medical staff services, managed care, Certified Professional Credentialing Specialist (CPCS), job, healthcare, medical, clinical, health care, clinic, primary care


Why GoHealth?

GoHealth Urgent Care has outstanding career opportunities in Connecticut, Missouri, New York City, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust them or burn them out, our team can balance and prioritize their professional and personal lives.

The lifestyle you can lead.

Welcome to the East Coast epicenter for commerce, finance, media, art, fashion, research, technology and entertainment. New York is among the world’s most linguistically and culturally diverse cities. Its many attractions include the Empire State Building, Statue of Liberty, Ground Zero Memorial, Metropolitan Museum of Art and Central Park. Enjoy the nighttime neon of Times Square. Ride the Staten Island Ferry, see a concert at Radio City Music Hall or catch an exciting Broadway show. Though New York is the city that never sleeps, it’s made up of regions that are great places to raise a family — Manhattan, Brooklyn, Queens, Staten Island, Long Island and Westchester County. And all offer a great selection of neighborhoods and homes, plus excellent schools and renowned local colleges and universities.