What are the responsibilities and job description for the Provider enrollment position at Sentara?
City / State
Richmond, VA
Overview
Work Shift
First (Days) (United States of America)
Job Summary
The primary role of the Provider Data Enrollment Specialists II 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 position is also responsible for remediating capitation-related provider data issues and regulatory-related research and updates.
This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.
BA preferred. Minimum of 3 years 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
Qualifications : Insurance
Insurance
Skills
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.
gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
Last updated : 2024-05-29
