Enrollment Specialist

Company Overview

Contentnea Health is a Community Health Center providing comprehensive medical, dental and behavioral health services for members of our communities in Greene, Pitt and Pamlico counties in eastern North Carolina.

Job Summary

Administers the enrollment process for participation in payer agreements for the organization, practice locations and individual practitioners.

Responsibilities and Duties

1. Ensures provider participation with contracted payers by performing appropriate actions to complete and maintain ongoing enrollment.
   1. Initiate requests to new and established practitioners for information needed to add or maintain enrollment with payers.
      1. Initiates data collection with newly hired providers using the onboarding process in the internal credentialing application.
      2. Prompts providers for licensure and certification renewals.
      3. Escalates instances of practitioner nonresponse to requested items.
   2. Completes payer enrollment applications while reviewing information to ensure accuracy and completeness.
   3. Identifies any discrepancies or adverse information noted from applications, primary source verifications or other sources utilized for enrollment functions.
   4. Ensures discrepancies are addressed promptly and the proper follow-up is completed in a timely manner.
   5. Responds to payer notifications with requested information to ensure enrollments remain in an active status.
      1. Submits rosters per payer specification.
      2. Completes practice and provider revalidations in a timely manner.
   6. Prepares the CAQH re-attestations for existing providers.
   7. Researches and resolves provider related enrollment issues and coordinates with members of various departments when applicable.
   8. Reviews individual payer manuals and bulletins to ensure compliance with enrollment processes.

1. Communicates enrollment status to stakeholders in a clear and timely manner.
   1. Maintains documentation and reporting regarding payer enrollments in process.
   2. Generates routine reporting and distributes to defined internal stakeholders.
   3. Provides routine enrollment reporting to external partners as assigned.

1. Supports maintenance of accurate practice information in internal applications, payer applications, stakeholder, and partner platforms.
   1. Maintains up to date information in internal credentialing software applications.
   2. Submits help desk tickets to update provider and/or practice information in the Practice Management and Electronic Health Record (EHR) systems.
   3. Maintains provider rosters in value-based care partner web-based portals as assigned.
   4. Responds to inquiries from stakeholders and partners with accurate practice and provider information.

Qualifications and Skills

Possesses work related skills at a higher level than completion of high school, including formal written and verbal communications skills, computational and computer skills, mathematical, technical or health care related knowledge frequently acquired through a para-professional or certificate type program.  

Possesses specific knowledge and training in credentialing processes and practices.  Will need to obtain certification as a Community Health Credentialing Specialist (CH-CS).