Provider Enrollment Specialist
Core
Support the enrollment process by reviewing, researching, analyzing, and processing medical provider applications to ensure file accuracy and compliance.
Role type
Provider Enrollment Specialist
Builds
Accurate provider enrollment files and compliant directories for Medicare
Domain
Healthcare administration / Government contracting
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
CMS 855 application management, PECOS utilization, Customer service representative (CSR) experience, Previous provider enrollment experience for Medicare
Preferred skills
Associate's or Bachelor's degree
Technologies
Microsoft Office
Responsibilities
Review and validate medical provider enrollment applications (initial, re-enrollment, reactivation, or updates), Verify provider data via internal databases and external agencies, Enter and update provider information in enrollment databases and directories, Communicate with providers, agencies, and internal departments to resolve discrepancies, Supply application materials and process guidance to potential enrollees, Assist with special projects, process improvements, provider education, and system testing
