Operation Associate - Payer / Provider Enrollment

Overview

Provider/Payer Enrollment

Responsibilities

• Enrollment and Credentialing: Prepare and submit provider enrollment applications, re-enrollments, and re-credentialing documents to commercial, Medicare, and Medicaid payers.
• Documentation Management: Maintain and update provider files with accurate information, including licenses, certifications, and other credentialing paperwork. This involves a high degree of attention to detail to prevent delays.
• Communication and Follow-up: Act as the primary point of contact with payer representatives to track application statuses, address issues, and resolve any denials or requests for additional information in a timely manner.
• Database Administration: Accurately enter and manage provider data within our credentialing and billing software, including systems like CAQH and PECOS.
• Compliance Monitoring: Stay current with changes in payer enrollment regulations and requirements to ensure all applications are compliant with state and federal guidelines.
• Internal Collaboration: Work closely with billing, coding, and provider relations teams to ensure a smooth and efficient process from provider onboarding to billing.
  

Qualifications

• Experience: At least 1 plus years of experience in Provider/payer enrollment, credentialing, or medical billing within the US healthcare system.
• Education: Bachelor's degree in healthcare administration or a related field is preferred.
• Technical Skills: Proficiency with Microsoft Office Suite (Word, Excel) and experience with credentialing software or payer portals (e.g., CAQH, PECOS).
  

Skills

• Exceptional attention to detail and organizational skills.
• Strong written and verbal communication skills.
• Ability to work independently, manage multiple deadlines, and problem-solve effectively.
• Knowledge of medical terminology and the US healthcare revenue cycle.