Provider Enrollment Associate Job at MMC Group LP (Helena)

Provider Enrollment Specialist II - HP Enrollment Eligibility

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care cred...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma
1-3 years of Payer Enrollment experience
Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
Excellent written and verbal communication skills
Excellent organization and planning skills with demonstrated teamwork skills
Proven ability to interact with all levels of management and other Associates

Job Responsibility

Collects and maintains data on providers for Medicare and Medicaid enrollment
Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
follows up by telephone or in writing, with carriers regarding application status
Complies with Medicare and Medicaid provider enrollment guidelines
Requests NPI numbers for providers and clinics as necessary and maintains NPI files
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
Generates various reports to identify outstanding claims issues with provider numbers and non-payment
Communicates information to appropriate personnel
Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
Collects and reviews managed care contracts for correct billing and payment terms

Fulltime

Provider Enrollment Specialist Senior

This role serves as a Payer Enrollment liaison. Represents Payer Enrollment on m...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
3-5 years of Payer Enrollment experience preferred
Solid knowledge and utilization of PC applications including Microsoft Word and Excel
Excellent written and verbal communication skills
Excellent organization and planning skills with demonstrated teamwork skills
Proven ability to interact with all levels of management and other Associates
In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Collaborates with CBO and local operations on enrollment related issues
Attends and provides enrollment related updates on matrix calls
Collaborates with Credentialing Team and local operations on items needed
Updates Credentialing/Payer Enrollment database as needed
Accesses payer databases as needed to ensure appropriate enrollment
Performs multi-state Medicaid Enrollment through state portals
Submits updates as needed to payers
Maintains internal enrollment database
Educates associates on enrollment processes when needed

Fulltime

Provider Enrollment Specialist

The Provider Enrollment Specialist ensures seamless plan enrollment (initial and...

Location

United States , St. Louis

Salary:

21.00 - 27.00 USD / Hour

Anders Minkler Huber & Helm LLP

Expiration Date

Until further notice

Requirements

Associate degree, preferred
High School diploma or GED required
3-5 years of experience in payer enrollment
Strong organizational and time management skills, with the ability to manage multiple tasks and meet deadlines
Excellent attention to detail and accuracy in data entry and record-keeping
Effective communication skills, both written and verbal, with the ability to interact professionally with providers, staff and external entities
Ability to work independently and as part of a team, demonstrating flexibility and adaptability
Strong problem-solving skills, with the ability to identify and resolve issues promptly and effectively
Knowledge of healthcare regulations and compliance requirements
Familiarity with NCQA, URAC, and CMS standards

Job Responsibility

Process and submit initial provider applications, revalidations, and renewal applications in compliance with NCQA, URAC, and CMS accreditation standards
Perform thorough and accurate data entry and verification of provider information into credentialing databases
Conduct timely follow-up on missing or incomplete information with the provider, client, or team lead responsible for a provider file to ensure prompt and efficient provider enrollment
Assist in the preparation and submission of required documentation for provider enrollment and credentialing to include delegation rosters
Coordinate with internal staff and external entities to resolve issues related to provider enrollment and credentialing
Monitor and track the status of provider applications, payer directories, conducting regular follow-up with health plans until verification of completion is received from each payor
Support the enrollment and delegation team with various tasks as needed

What we offer

Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer
Professional development opportunities
Benefits that directly impact mental, physical and financial wellness

Fulltime

Nurse Practitioner

The Nurse Practitioner (NP-S) practices as a member of the interdisciplinary hea...

Location

United States , Long Beach

Salary:

79.78 - 99.50 USD / Hour

MemorialCare

Expiration Date

Until further notice

Requirements

Three to five years of experience as a registered nurse in a general care or intensive care environment
Current license as a Registered Nurse (RN) in the State of California
Current certification as a Nurse Practitioner (NP) in the State of California
Current furnishing license to furnish medications in the State of California
An individual Drug Enforcement Agency (DEA) License issued by the United States DEA for Schedule III-V controlled substances
Certification as a Nurse Practitioner (NP) from an agency accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC)
Current American Heart Association Basic Life Support (BLS) certification
Current American Heart Association Advanced Cardiovascular Life Support Certification (ACLS) and/or Pediatric Advanced Life Support (PALS) from the per department requirements
Must have a National Provider Identifier (NPI) and be enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) within 90 days of hire
ATLS within 8 months of hire

Job Responsibility

Independently examines, diagnoses, orders diagnostic studies and treatment for patients using approved standardized procedures
Evaluates the effectiveness of interventions and changes treatment as indicated
Coordinates, prioritizes and organizes individual patient care in collaboration with supervising physician(s)
Collaborates with members of the healthcare team to create a patient plan of care
Provides individualized patient and family education and documents in the patient teaching plan
Communicates with supervising physician and physician consultants treating the patient
Anticipates discharge on admission and plans accordingly
Ensures accurate patient problem list and medication reconciliation on admission and discharge
Utilizes age specific competencies for culturally diverse patients
Ensure accuracy of acuity with appropriate diagnostic documentation

What we offer

Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents
There may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities

Parttime

Manager of Enrollment Services

Westside Family Healthcare is a nonprofit organization that provides high qualit...

Location

United States , Bear

Salary:

Not provided

Westside Family Healthcare Inc

Expiration Date

Until further notice

Requirements

High school diploma or GED
Three or more years of experience working in healthcare, community relations or health insurance
Two or more years of experience with providing application and enrollment assistance for state and federal healthcare programs such as Medicaid, Screening for Life and the Health Insurance Marketplace
Experience managing employees in remote locations
Public speaking experience with the ability and willingness to speak at public events
Proficient in Microsoft Outlook, Word, Excel and PowerPoint with three or more years of experience
Valid driver’s license, reliable transportation and ability to travel independently between work locations
Willingness to submit to a criminal background check in accordance with
Three letters of reference from members of the community

Job Responsibility

Supervision and HR Management: Directly supervise the Assistance Manager of Enrollment Services, the Community Navigator Supervisor, and the team of Enrollment Specialists
Collaborate with HR and Associate Director of Enrollment Services for the recruitment, screening, hiring, training, and performance management of staff
Provide ongoing performance feedback, conduct formal evaluations, implement corrective actions, and manage employment terminations when necessary
Conduct weekly and quarterly one-on-one staff check-ins with staff
Grant Management and Resource Allocation: Work closely with the Associate Director of Enrollment Services and Director of External Affairs to meet grant deliverables
Effectively manage resources to support outreach and in-reach activities
Assistance to Patients and Consumers: Maintain federal navigator certification
Provide assistance to individuals in financial support for health care services, including through the Health Insurance Marketplace
Staff Education and Internal Referral System: Maintain expert-level knowledge of all state and federal programs and relay that information to staff
Collaborate with the Lead Enrollment Specialist and the Associate Director of Enrollment Services to develop and deliver monthly and as needed training sessions for Enrollment Services staff

What we offer

medical insurance
dental insurance
vision insurance
life and disability insurance
a 401(k) retirement plan with a match
supplemental insurances
generous PTO package
flexibility to provide work/life balance

Fulltime

Credentialing Specialist

We are seeking a Credentialing Specialist for a short term contract in Nashville...

Location

United States , Nashville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent (Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred)
1–3 years of experience in healthcare credentialing, provider enrollment, or medical staff services
Knowledge of payer enrollment processes (Medicare, Medicaid, commercial payers)
Familiarity with credentialing standards and regulatory requirements
Proficiency with credentialing software, provider databases, and Microsoft Office (Excel, Word, Outlook)
Strong organizational skills with high attention to detail
Excellent written and verbal communication skills

Job Responsibility

Coordinate and process initial credentialing, recredentialing, and payer enrollment for healthcare providers
Collect, verify, and maintain provider documentation including licenses, certifications, education, training, work history, NPIs, and DEA registrations
Prepare and submit credentialing and enrollment applications to insurance payers, hospitals, and regulatory bodies
Monitor credential expirations and proactively manage renewals to maintain continuous provider eligibility
Maintain accurate and up‑to‑date credentialing records in credentialing software and internal databases
Serve as a liaison between providers, payers, medical staff offices, and internal departments
Track application statuses, follow up on outstanding items, and resolve credentialing or enrollment issues
Ensure compliance with CMS, NCQA, Joint Commission, state, and payer credentialing requirements
Support audits and accreditation reviews by preparing and providing credentialing documentation
Maintain strict confidentiality of sensitive provider information

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Credentialing Enrollment Specialist

Location

United States , Charlotte

Salary:

24.10 - 36.15 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

High school diploma or GED required
Bachelor's degree preferred
Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment
Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone
Experience in typing, word processing, and business correspondence
Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred

Job Responsibility

Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers
Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office
Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants
Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner
Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities
Conducts practice site visits for practices within MGD
Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System
Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation
Provides Team member support to the CPN Credentialing and Quality Review Committee

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Director of Admissions and Enrollment Marketing

The Director of Admissions and Enrollment Marketing is responsible for the strat...

Location

United States of America , Rochester

Salary:

86482.00 - 129723.00 USD / Year

University of Rochester

Expiration Date

Until further notice

Requirements

Bachelor’s degree and 5 years of higher education experience required
Master’s degree in higher education student services, higher education administration, nursing, or related field preferred
Six years of related senior administrative experience in admissions preferred
or equivalent combination of education and experience required
senior-level admissions and enrollment management and/or experience in higher education with a proven track record of success
specific areas of expertise include managing conversion and yield strategies, increasing applications and enrollments through innovative market outreach and building professional networks and student pipelines
experience working with diverse student populations preferred
highly collaborative
excellent oral and written communication skills
demonstrated creativity and flexibility to respond to emerging and changing enrollment environments is strongly preferred

Job Responsibility

Direct all phases of the admissions process: review applications for admissions for undergraduate and graduate programs and make final recommendations for admission and financial aid decisions
Lead Admissions Committee on all related application process decisions
Maintain and continuously improve high standards for the school-wide holistic admission review process
Generate and utilize ongoing analysis of holistic admission process including effects of variables on matriculation
Work collaboratively with faculty and School of Nursing Committees to oversee admissions policies
Manage net tuition revenue targets
Work closely with the senior leadership team to ensure balance in the entering class size, financial aid expenditures, tuition pricing, and net tuition revenue goals
Long-term strategic planning: Guide strategic discussions regarding multiple and often competing enrollment goals, including class size, academic quality and net tuition revenue
Provide context and a broad perspective on national and international market dynamics and challenges
Assess the effectiveness of the University of Rochester’s School of Nursing financial aid policies and strategies

Fulltime

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Provider Enrollment Associate

Job Description

Job Responsibility

Requirements

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What we offer

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