What are the responsibilities and job description for the Provider Data and Enrollment Specialist II position at Sentara?
The primary role of the Provider Data Enrollment Specialist I is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider setup to initiate credentialing, provider record updates and edits, processing provider terminations, and researching and resolving provider setup issues in the applicable systems. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.
Minimum of 1-year experience in healthcare insurance working with provider, network, or contract data; or a combination of education and experience, which would provide an equivalent background
Understanding health claims processing is a plus
- High School Grad or Equivalent
- Insurance 1 year
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