Provider Enrollment Specialist

Accurately complete the enrollment/ re-enrollment processes as outlined by each network/area for all appropriate healthcare providers. These will be identified through department policies, network reimbursement and delegated contracts to ensure timely and continued provider network participation.

Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanned hardcopy documents, while appropriately following each stage of the enrollment/re-enrollment process thoroughly and respecting Nemours process for PHI.

Accurately maintain all internal systems with the appropriate provider and network participation information. Systems including, but not limited to, ECHO, Excel, PET Tracker, iGuide, Qliksense, the NPL tracker, internet, Outlook, and word processing.

Performs follow up with health plans and their representatives to expedite participation approval by each health plan.

Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information and to facilitate the provider enrollment/re-enrollment process.

Develop and maintain relationships with Network Representatives to facilitate the provider enrollment/re-enrollment processes and maintain accurate data in the plan directories.

Responsible for sending enrollment applications to providers, as appropriate, to maintain signatures and demographic information.

Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies, and systems. Additionally, each team member is expected to cross train on plan requirements to assist one (or more) other team member(s) in completing assigned duties.

Will assist with special priority projects and other miscellaneous duties and responsibilities, as assigned by employee’s supervisor or department leadership.