Provider Enrollment Specialist

Overview

We have a Provider Enrollment Specialist career opportunity for an experienced professional to join our team at Pediatrix Medical Group. We are a national organization, and one of the nation’s largest providers of prenatal, neonatal and pediatric services.

Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere. We are confident that you'll love being a part of the Pediatrix team.

Responsibilities

The Provider Enrollment Specialist II is responsible for timely and effectively enrolling practitioners in health plans. The Provider Enrollment Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates as needed to the appropriate RCM central business offices. The Provider Enrollment Specialist II will assist Management in maintaining provider enrollment goals for all divisions.

• Validates up-to-date plan enrollment forms, completes applications, submits them to plans and follows up until enrollment is complete. Verifies accuracy and coordinates entry of new and revised provider information into IntelliCred and Master Database.
• Mapping forms in IntelliCred and prioritizing work, reviewing and researching Health Plan Enrollment requirements at Corporate Business Office.
• Documents assignments in the Credentialing/Provider Enrollment tracking system per the department’s standard operating procedures.
• Contacts health plans to determine enrollment requirements periodically and verify health plan requirements based on the specialty and confirm the most up to date enrollment application forms are readily available in Provider Enrollment Tracking Software (IntelliCred).
• Prepares/reviews group applications based on information provided during acquisitions, Tax ID mergers, and Organic Growth Initiatives (OGI).
• Communicates with Business Development, Business Integration and Credentialing to acquire prospective new provider group’s required documents and/or signatures as needed.
• Knowledgeable in reporting system functionality, mapping forms utilizing Provider Enrollment tracking software and IC system Q/A delegate.
• Maintain provider’s profile in PE Tracking system (IC) with up to date with information on active or pending providers by completing all data fields in the Demographics, Appointments and Applications screen for the provider and group practice.
• Maintain provider’s profile in CAQH with up to date with information on active or pending providers by completing all data fields pertaining to demographics, service locations, group entity information, required documents and expirables.
• Monitors all assigned delegated agreement health plan enrollments reports utilized to provide oversight to ensure enrollments currently assigned are being processed timely. i.e.: To Do List in IC, IntelliReports, IC Weekly aging, and IC End of Month.
• Validates status of on boarding provider’s enrollments to ensure Target Start Date is met. Escalates to Provider Enrollment management when necessary in order to meet desired Target Start Date.
• Performs other job-related duties within the job scope as requested by Provider Enrollment Management.

Qualifications

Education/Experience:

• Associate's degree (A. A.) or equivalent from two-year college or technical school.
• Three (3) or more years related experience or equivalent combination of education and experience.
• Knowledgeable with Group Entity health plan enrollments, state regulations and appeal processes.
• Knowledgeable in Provider Enrollment policies and procedures and ensuring they are being followed and keeping the loss of revenue from delayed enrollments at a minimum
• Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conforms to prescribed style and format.
• Ability to effectively present information to top management, public groups, and/or boards of directors.

• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

• Understanding of medical terminology and protocols

Software:

Experience in Excel, Word, Adobe Professional, Pediatrix Master Database, OnBase, WorkView, hCue (Entity database software)

CAQH, and Credentialing/Provider Enrollment Tracking Software (IntelliCred).

Benefits and Compensation

Benefits for Full Time employees and qualified dependents:

• Medical, Prescription, Dental, Vision Insurance
• Progyny Fertility Benefits
• Livongo Diabetes Management
• Teladoc Health and Second Opinion Services
• Smart Shopper
• 401(K) Thrift Program & Sharing Plan**
• Employee Stock Purchase Plan (ESPP) – 15% discount*
• Basic Employee; Spouse; Child Life Insurance
• Accidental Death and Dismemberment (AD&D)
• Employee Optional Life and AD&D
• Short & Long Term Disability
• Pre-Tax Health Savings Accounts (HSA)
• Employee and Dependent Flexible Spending Account (FSA)
• Family Medical Leave Act (FMLA)**
• Parental Leave Benefit
• Sick Pay Bank
• Employee Assistance Program (EAP)**
• Group Aflac Policies
• Identity Theft Protection
• Employee Charitable Fund
• Care.com
• Various Discount Programs

*Part Time Regular employee classifications also receive this benefit

**Available to part-time regular and part-time casual employees aged 21 and over

About Us

Pediatrix Medical Group is one of the nation’s leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives.

Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: www.pediatrix.com/careers.

#PedNC

Pediatrix is an Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.