Provider Enrollment Specialist

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• And more

Overview:

• The Provider Enrollment Specialist coordinates the enrollment and onboarding of physicians and advanced practice providers into the Emory Healthcare Network (EHN), a clinically integrated network.
• This position serves as the primary liaison between providers, internal credentialing teams, and network administration to facilitate timely provider enrollment and onboarding.
• The Specialist maintains provider records, verifies compliance with EHN participation requirements, monitors credentialing and payer enrollment activities, and supports an efficient provider onboarding experience.

Primary Duties and Responsibilities:

• Provider Enrollment and Onboarding: 1. Coordinates provider onboarding, enrollment, and credentialing activities for physicians and advanced practice providers joining the Emory Healthcare Network. 2. Tracks provider enrollment applications and collaborates with providers to ensure all onboarding requirements are completed accurately and within established timeframes. 3. Monitors provider participation status and payer effective dates and communicates enrollment status updates to providers upon completion.
• Credentialing and Compliance: 1. Validates provider compliance with Emory Healthcare Network participation criteria and strategic alignment requirements. 2. Verifies the completeness and accuracy of provider enrollment applications and supporting documentation. 3. Supports compliance with applicable enrollment, credentialing, and participation requirements throughout the onboarding process.
• Data Management and Documentation:1. Maintains accurate provider demographic, credentialing, and participation information within enrollment systems. 2. Updates and monitors provider records to ensure accurate and current information is maintained throughout the enrollment process.
• Provider and Internal Customer Support 1. Serves as the primary liaison between providers and internal departments throughout the enrollment and credentialing process. 2. Facilitates a seamless transition from the Emory Healthcare Network onboarding process to the Emory credentialing process. 3. Responds to provider inquiries and provides guidance regarding enrollment requirements and application status. Additional Responsibilities Performs other duties as assigned.

Travel: Less than 10% travel may be required.

Work Type: Hybrid position with responsibilities performed both remotely and in an office environment.

Minimum Required Qualifications:

• Education - High School Diploma or equivalent.
• Experience - One (1) to three (3) years of experience in provider enrollment, credentialing, medical billing, or a related healthcare administrative function.

Knowledge, Skills, and Abilities (Required):

• Knowledge of medical terminology, provider credentialing processes, payer contracting, provider reimbursement, and physician practice operations.
• Knowledge of healthcare provider enrollment processes, including maintaining provider records and application documentation.
• Proficiency with credentialing software, Microsoft Office applications (Excel and Word), and payer web portals.
• Ability to accurately review, verify, and maintain provider enrollment and credentialing documentation.
• Strong organizational skills with the ability to manage multiple priorities and meet established deadlines.
• Strong analytical and problem-solving skills with exceptional attention to detail.
• Excellent verbal and written communication skills with the ability to effectively collaborate with providers and internal stakeholders.
• Ability to work independently and effectively in a fast-paced environment while maintaining a high degree of accuracy.

Preferred Qualifications:

• Education - Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• Experience - Experience with Medicaid and Medicare provider enrollment processes.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at [email protected]. Please note that one week's advance notice is preferred.