Provider Network Specialist jobs in Bradenton, FL

PROVIDER ENROLLMENT SPECIALIST

Bradenton, FL

$21/RH

TEMP-TO-PERMANENT

POSITION SUMMARY: The Provider Enrollment Specialist assists with all aspects of the insurance provider enrollment process for the organization. Enrollment includes both facility and professional providers to participate in government programs and commercial payer networks. The Credentialing Specialist (Insurance) maintains excellent relations and liaison between payers, clinics, and providers to assist in ensuring participation status is managed in a timely and accurate manner. He/she supports compliance & Principles of Responsibility, maintains confidentiality, protects organizational assets, and exhibits ethics & integrity.

JOB ESSENTIAL DUTIES:

•Complete insurance enrollment applications in accordance with the organization standards, state & federal regulations, guidelines, procedures & laws required in credentialing process

•Responsible for initial credentialing with insurance companies.

•Ensure that the credentialing and re-credentialing process is completed in its’ entirety in a timely manner by individual providers, as well as by the organization

•Responsible for notifying the appropriate managers of any credentialing issues, status on outstanding applications, changes with contracted insurance companies and new plans within the company’s services delivery area

•Handle telephone communications to answers credentialing and staff questions regarding provider participation, credentials, documentation, etc.

•Obtain signatures in the field as required to complete the credentialing process.

•Supports the goals and mission of MCR Health

•Adheres to the safety policy of MCR Health

•Performs other duties as assigned from time to time

SKILLS, KNOWLEDGE & ABILITIES:

•Active Listening

•Writing

•Oral Expression

•Critical/Strategic Thinking

•Problem Solving

•Impact and Influence

•Customer Service Focus

•Time Management

•Ability to multi-task

•Empathy

•Ability to maintain confidences

•Ethical

•Ability to motivate

•Leadership

REQUIREMENTS & PREFERENCES:

•High School Graduate or GED equivalent

•Minimum of two (2) years of experience preferred

•Must be able to organize data for easy retrieval

•Must have working knowledge in Managed Care

•Must have working knowledge in Medicaid, Medicare and private insurance

•Must have experience and/or education in computer data entry

•Must demonstrate interpersonal skills in written and oral communication, problem solving, and teamwork

•Must have excellent grammar skills

•Must be able to meet deadlines and complete assignments in a timely manner

•Medical terminology knowledge helpful

•Must be able to work with minimal supervision

•Must be courteous, helpful and maintain patient confidentiality

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