Provider Enrollment Specialist

Provider Enrollment Specialist

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Hours : 8 : 00 AM- 4 : 30 PM; Monday through Friday $17 per hour, which may be below your state's minimum wage. Please take this into consideration when applying.

Job Description :

Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates. This involves accurate and timely entry of provider data, including provider applications and contact information, status changes, and revalidations. It also includes verification of all the credentialing criteria for providers that have applied to NH Medicaid through initial application, and following up with providers as needed to obtain information for the enrollment process.

Job Duties and Responsibilities :

• Enter and maintain provider applications, revalidations, and updates into the system.
• Enter and maintain all provider information into database.
• Verify prospective and current providers' license, NPI, and other required enrollment documentation.
• Verify accurate banking and billing information.
• Perform ongoing research to correct data so that it does not create duplicate providers, locations, and participation statuses.
• Maintain provider information by reviewing, entering, and following up on missing information.
• Track contract applications status.
• Ensure all files have a welcome, denial, or term letter as appropriate.
• Meet required turnaround times and accuracy rates.
• Keep up-to-date provider enrollment process and records, and track provider participation levels.
• Outreach providers because of mail being returned undelivered to XYZ COMPANY.
• Update the system and the credentialing database to reflect approvals, denials, and / or terminations.
• Facilitate provider-related research based on suspended claims, Call Center escalations and other feedback opportunities.
• Assists call center agents, all internal departments, providers, and potential providers with resolving Provider Enrollment issues and inquiries
• Meets quality controls and production standards of the Provider Relations Department
• Assist with other duties as assigned.

Required Skills :

Required Experience :

Preferred Experience :

Pay Transparency Laws in some locations require disclosure of compensation and / or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and / or sick time.

The estimated hourly rate for this role is $17.00

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex / gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military / veteran status, citizenship status, basis of genetic information, or any other group protected by law.