Provider Enrollment Specialist
This Provider Enrollment Specialist is responsible for the timely enrollment of new physicians and ongoing maintenance of existing providers. Enrollment includes but is not limited to managed care organizations and government payors such as Medicare, MA Medicaid and out of state Medicaid.
- Responsible for data entry of provider enrollment information into Provider Enrollment Database systems and distribution of information to designated department representatives and credentialing administrators.
- Accountable for all aspects of provider enrollment to ensure provider data is loaded appropriately in all relevant systems the first time. This includes understanding and communicating unique arrangements and ensuring the third party payors accurately credential the provider.
- Accountable for directly entering and updating provider data into the CAQH system.
- Follow-up with managed care organizations to ensure expedient credentialing.
- Accurately perform review of new enrollment files for deficiencies.
- Pursue incomplete information with practice contact or provider.
- Ensure third party payor provider enrollment is done in a timely and accurately in order to receive reimbursement.
- Responsible for the implementation and maintenance of provider and third party payor files within practice management software.
- Ensure that practice, provider and payor related tables are established and properly working.
- Responsible for the ongoing maintenance of existing providers including but not limited the submission of maintenance forms to update personal and practice demographic data for providers and billing updates.
- Accountable for submitting termination requests to all health plans in a timely manner.
- Other duties as assigned.
- Associates degree required or equivalent combination of education and experience.
- National Association of Medical Staff Services (NAMSS) CPCS certification a plus.
- 3-5 years of working experience in a healthcare setting is required.
- Knowledge of provider credentialing and/or enrollment required.
- Knowledge of billing processes preferred.
Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.
Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and mask policy is required for patient and colleague safety.
Steward Health Care is the largest private, for-profit health care network in the United States. The company is owned and led by a management team of Steward physicians. Headquartered in Dallas, Texas, Steward employs more than 40,000 health care professionals and operates 35 hospitals across the United States and in the countries of Malta and Colombia which regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, more than 7,000 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.
The Steward Health Care Network includes more than 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters annually. Steward Medical Group, the company's employed physician group, provides more than six million patient encounters per year. The Steward Hospital Group operates hospitals in Malta, Colombia and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit