Provider Enrollment Specialist Overview

About Us:

Somnia Anesthesia, Inc is a leading healthcare organization dedicated to providing exceptional patient care and services. We are committed to excellence and innovation in the healthcare industry. 

Provider Enrollment Specialist Position Summary:

The Provider Enrollment Specialist will be responsible for coordinating the requests for participation in health insurance network as a medical provider, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. They will also review provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements. 

Provider Enrollment Specialist Responsibilities

• Validates up-to-date plan enrollment forms, completes applications, submits and follows up until enrollment is complete. Verifies accuracy and coordinates entry of new and revised provider information into database.
• Knowledgeable with Group Entity health plan enrollments, state regulations and appeal processes.
• Prepares/reviews group applications based on information provided during acquisitions, Tax ID mergers, etc.
• Validates status of on boarding providers enrollments to ensure target start date is met. Escalates to management, when necessary, in order to meet desired target start date.
• Responsible for the on-going maintenance of existing providers including but not limited the submission of maintenance forms to update personal and practice demographic data for providers, billing updates, etc
• Experience with various provider enrollment software and related applications and PECOS Experience completing 855B, 855I, and 855R Medicare enrollment/credentialing and revalidation in a timely manner. 
• Payer Enrollments with Government, Managed Care and Commercial Payers
• Resolve enrollment issues through office staff, management, and others as identified. Maintains positive working relationships with providers.
• Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
• Proactively obtains updated provider credentialing data prior to expiration. Completes all additions, updates, and deletions.
• Proactively provides update provider rosters to payers as need/requested. 
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc. 
• Develops databases and spreadsheets for tracking organization providers. 
• Continuously searches for process improvements to achieve accuracy and efficiency.
• Performs other duties as assigned or required

Provider Enrollment Specialist Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree in finance, accounting, healthcare administration, or a related field is preferred.
• Minimum of 3 years of experience in anesthesia enrollment.
• 5 years experience in PECOS & Medicare, Other payer enrollments.
• Proficiency in Microsoft Word, Excel, Outlook, PDF Software, PE Software and other management tools.
• Strong project management and multitasking skills.
• Excellent communication and interpersonal skills.
• Strong writing skills and attention to detail.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience within Anesthesia payer enrollment preferred.
• Additional certifications and extensive experience with multiple PE software platforms preferred.