Provider Enrollment Specialist, II

Provider Enrollment Specialist 

The Provider Enrollment Specialist will provide direct enrollment support to clinical providers to achieve desired enrollment effective dates with the Medicare Administrative Contractor (MAC), State offices for Medicaid or to achieve licensure with the desired or requested State Licensing Board. Responsibility of the Provider Enrollment Specialist will include ensuring that Matrix Medical Network is in 100% compliance with all Medicare and Medicaid enrollment and participation regulations and guidelines. The Enrollment Specialist will also maintain Medicare and/or Medicaid enrollments throughout the provider’s tenure with Matrix Medical Network.

Organizational contributions:

The Provider Enrollment Specialist at Matrix Medical Network will provide assurances to the organization and client health plans that providers are appropriately and adequately licensed and/or enrolled in Medicare and Medicaid.

Interacts with:

The position interacts with leadership at all levels within the organization and works closely with Credentialing team members and leadership along with Production, Planning & Control and Clinical Recruitment as needed for projects.

• Submit and process initial enrollment applications and re-enrollment applications to Medicare and Medicaid and/or submit and process initial enrollment applications with State Licensing Boards as assigned by leadership
• Maintain the accuracy of provider enrollment information in the designated software
• Populate and prepare enrollment applications for providers
• Responsible for following up on outstanding enrollment information and/or paperwork from providers, State Licensing Boards, Board Certification Bodies, etc.
• Review provider applications for accuracy and completeness
• Track and follow up on enrollment or re-enrollment applications with Medicare and Medicaid until provider enrollment or re-enrollment is completed and/or track and follow up until state license is issued
• Responsible for provider file maintenance for Medicare and Medicaid, including but not limited to provider name changes, license updates, required attestations and any other required data
• Establish and maintain professional working relationships with business partners and work as a team to resolve issues related to enrollment in a timely manner
• Work reports that identify enrollment issues distributed by leadership
• Complete reports provided by leadership by assigned deadlines
• Notify appropriate key business partners once provider license is issued or enrollment numbers are received
• Assist with roster reconciliation projects with health plan clients
• Demonstrate exemplary customer service to Medicare and Medicaid representatives, State Licensing Boards, providers and other Matrix Medical Network employees
• Meet targeted enrollment deadlines
• Communicate risk to leadership as soon as identified
• Consistently meet Matrix Medical Network set productivity and quality standards
• Proficiently use the Matrix Medical Network credentialing systems as instructed by leadership
• Maintain the Matrix Medical Network credentialing and enrollment database as it pertains to enrollment and licensure
• Contribute to the advancement and growth of the department
• Performs other duties as requested
• Adhere to the Matrix Medical Network Standards of Conduct
• Adhere to Matrix Medical Network policy and procedures

Education Requirements

• High School graduate or equivalent. AS or B.S. degree in business administration or health care related field is a plus

Required Skills and Abilities

• Two years of enrollment experience including Medicare and Medicaid and/or provider healthcare licensing
• Knowledge of organization’s policies, procedures and systems
• A working knowledge of the enrollment process and requirements
• Knowledge of standards and guidelines as they apply to Medicare, Medicaid
• Knowledge of standards and guidelines as they apply to State Licensing Boards and the Enhanced Nurse Licensure Compact
• Knowledgeable with NPPES website and NPI Accounts
• Skilled in computer applications including MS Word, MS Excel and database administration
• Have excellent customer service skills
• Have strong organizational and time management skills
• Ability to be flexible to change and growth
• Ability to work effectively in a fast paced, high volume environment
• Demonstrate ethical problem-solving skills
• Skilled in professional verbal, written and email communications
• Ability to work effectively with staff, physicians and external customers
• Ability to work independently with limited supervision

Core Competencies

• Analytical Thinking
• Computer Skills
• Critical Thinking
• Self-Direction
• Timely Decision Making

Supervisory Responsibility: There will not be supervisory responsibility with this role.

Travel Requirements: <25%

Work Conditions: General office environment.