Provider Enrollment Specialist

Key Responsibilities

• Enroll providers and practitioners in provider data management systems.
• Update provider records with claims payment details and directory information.
• Research, review, and process provider-requested updates.
• Validate provider data for accuracy and completeness across multiple systems and applications.
• Perform quality checks on claims-related data and provider directory information.
• Research discrepancies, investigate issues, and implement appropriate updates.
• Manage daily assignments according to priority and productivity goals.
• Collaborate with internal departments to respond to provider data inquiries and complete special projects or reports.

Requirements & Tech Stack

• Data Entry and Accuracy: Enter, review, and update provider information while maintaining data integrity.
• Microsoft Excel and Office: Use Excel and other Microsoft applications to review, analyze, and validate data.
• Organization and Adaptability: Manage daily assignments, adjust to changing priorities, and meet productivity expectations.
• Proficiency in Microsoft Excel and other Microsoft Office applications.
• Strong organizational skills and the ability to analyze information, resolve discrepancies, and manage multiple priorities.

Qualifications

• Education:
• Associate degree; or
• High school diploma or equivalent with at least one year of data entry, data analysis, or customer service experience.
• Preferred Experience:
• Experience in healthcare operations, including claims processing, billing, provider relations, contracting, or credentialing.
• Experience with provider data management in a managed care, insurance, or medical office environment.
• Experience researching information, resolving discrepancies, and maintaining accurate records.