Provider Enrollment Specialist

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🔥 2 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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T3Cogno

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2022

👥 HR Tech

🤝 B2B

HR Tech • B2B • Consulting

T3Cogno is a professional HR services provider specializing in talent acquisition, HR consulting, and technology-driven solutions to enhance workforce management. With over 25 years of experience, T3Cogno empowers organizations by offering a comprehensive suite of services including virtual HR management, payroll solutions, and strategic advisory aimed at optimizing human resources. The company is dedicated to driving business growth and employee success, making them a trusted partner across various industries.

📋 Description

• Responsible for coordinating requests for participation in health insurance network as a medical provider • Monitoring and maintaining provider enrollment and re-enrollment process in a timely and compliant manner • Reviewing provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements • Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner • Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others • Maintains positive working relationships with providers • Plays an active role in explaining providers and practice/office managers the submission requirements for credentialing/recredentialing processes • Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc. • Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data • Proactively obtains updated provider credentialing data prior to expiration • Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions • Completes all additions, updates, and deletions • Supports new provider onboarding processes as related to enrollment • Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner • Fosters working relationships and teamwork with departments, vendors, etc. • Develops databases and spreadsheets for tracking organization providers • Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management • Continuously searches for process improvements to achieve accuracy and efficiencies • Performs other duties as assigned or required

🎯 Requirements

• California market experience is key • Must have experience with Department of Labor enrollments • Healthstream experience is preferred • Prior experience with internal auditing is key • CAQH experience is a plus • High School Diploma or equivalent • 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements • Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools • Motivated to quickly learn and demonstrate strong problem-solving skills • Strong project management and multitasking skills • Excellent interpersonal and communication skills • Strong writing skills and attention to detail • Strong organizational skills and ability to be attentive to details • Demonstrated knowledge of healthcare contracts preferred

🏖️ Benefits

• Joining comes with an array of benefits • flexible work hours when possible • genuine sense of belonging to a dynamic and growing organization • Access to a 401(k) Retirement Savings Plan • Comprehensive Medical, Dental, and Vision Coverage • Paid Time Off • Paid Holidays • Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services