Provider Enrollment Specialist

Job description

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Coordinates and facilitates the enrollment of Allegheny Clinic professional providers with various payers for professional services reimbursement. Reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements. Obtains information from professional providers and other sources. Completes timely application processes based on payer specific formats. Continually follows up on enrollment and/or recredentialing statuses until complete. Resolves issues as they are identified in a timely manner. Maintains systems/applications used in the enrollment processes. QUALIFICATIONS: Minimum - Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner. Handles highly sensitive and confidential information regarding professional providers. (50%) - Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified. Maintains positive working relationships with providers. Plays an active role in explaining and...