Provider Enrollment Associate

Job Purpose

The Provider Enrollment Associate is responsible for credentialing / enrolling new and established health care providers and maintenance of required information.

Duties and Responsibilities

• Communicates with providers to explain process and sign applications
• Collects, updates, maintains necessary provider information and documentation and verifies the information where possible
• Establishes and maintains data entry in CAQH
• Prepares provider enrollment applications for all initial applications and re-credentialing in a timely and complete manner
• Verifies provider and group information with insurance companies (addresses, contracted plans, provider ID numbers, etc.)
• Coordinates information for enrollment and termination of all providers
• Handles enrollment with Medicare, Medicaid, commercial insurances
• Contributes to the departmental process and procedures with a collaborative approach
• Works department client WQ’s and smart feeds where applicable
• Maintains provider enrollment mailbox and completes actions and follow up
• Performs other duties as requested
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

Working Conditions

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.