Provider Enrollment Specialist

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🌪️ Kansas, Oklahoma, +2 more states – Remote

🌪️ Kansas – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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OU Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

OU Health is a comprehensive healthcare provider offering a wide range of medical services including pediatric care, cancer care, diabetes care, emergency care, and specialized services for adults and children. Located in Oklahoma, OU Health operates multiple facilities such as the Oklahoma Children's Hospital and the Stephenson Cancer Center. Known for its advanced scientific research and quality care, the organization prides itself on being recognized for excellence in areas like pediatric cardiology and heart surgery. As part of its commitment to medical excellence, OU Health also focuses on medical education and research, helping to train the next generation of healthcare professionals.

📋 Description

• Execute the full provider enrollment lifecycle, including contract initiation, reassignment of benefits, and maintenance of billing privileges • Manage group practice location information in the enrollment database, including clinic hours, NPIs, contract numbers, and contact information • Participate in delegation oversight reviews as a technical resource for health plan reviewers • Create complex ad-hoc reports and rosters for health plan data requests and delegation reporting • Communicate with health plan and delegation oversight representatives regarding NCQA standards and implementation • Use government and state-specific healthcare enrollment portals to maintain provider records and billing eligibility • Communicate with Revenue Cycle to resolve enrollment roadblocks and ensure reimbursement accuracy • Coordinate maintenance of National Provider Identifiers in national registries • Analyze practitioner sanctions and adverse disclosures for accurate, discreet health plan communication • Submit revalidations and contract renewals while identifying eligibility gaps • Track health plan effective dates and provide real-time enrollment updates • Resolve complex claim holds and denials caused by credentialing or enrollment discrepancies • Perform other duties as assigned

🎯 Requirements

• High School diploma or G.E.D. required • At least 3 years of experience in provider enrollment, health plan administration, or medical staff services required • Certified Provider Enrollment Specialist (CPES) or Certified Provider Credentialing Specialist (CPCS) by NAMSS required, or obtained within 12 months of hire • Advanced knowledge of NCQA accreditation standards and provider enrollment regulations • Ability to communicate with health plan auditors and executive leadership • Mastery of healthcare database functionality, including complex rosters and custom data extracts • Advanced understanding of government enrollment portals and national provider registries • Ability to manage complex group practice data across multiple locations and Tax IDs • Ability to identify process bottlenecks and implement collaborative solutions • Skill in analyzing health plan contracts and enrollment requirements • Candidates must reside and work full-time in Arkansas, Kansas, Missouri, Oklahoma, or Texas before their first day of employment

🏖️ Benefits

• Competitive wages and total rewards package • PTO • 401(k) • Medical plans • Dental plans • Comprehensive benefits and compensation package • Clinical and non-clinical opportunities to further your career • Reasonable accommodations for qualified individuals with disabilities