Job Description Summary

South Shore Health (SSH) is seeking a part-time Provider Enrollment Specialist with high touch customer service and excellent communication skills to join our Provider Enrollment Team. This hired candidate will work 8 hours per week, with flexible scheduling based on the candidate's availability. The Specialist will be responsible for all aspects of provider enrollment/credentialing for our primary care, specialist, behavioral health providers and newly incorporated disciplines and specialties for the health system.

Job Description

• Responsible for timely and accurate payer enrollments for 20 plus third-party affiliated payer plans and products, including Government and National Payer contracts
• Perform verification of application/documents, submission of requests for consideration, initial and revalidation applications, approval, denial, termination letters, primary source verification activities, and accurately maintaining the provider information in the new Credentialing System.
• Maintenance and updates of the CAQH (Council for Affordable Quality Healthcare) database for all providers and completing the provider or payer revalidation applications.
• maintain all active workflows with timely and concurrent touchpoints that highlight the ongoing communication and forward progression of the enrollments with all payers
• Work closely with internal and external customers and colleagues, including providers and clinical staff, Medical Staff Office, Provider Onboarding, Human Resources, IDN and all payers, to achieve optimal results timely payer enrollments, reimbursement, communications and overall effectiveness

Qualifications

• HS Diploma (Bachelors degree preferred)
• 3+ years of experience working with credentialing/payer enrollment software
• Provider Enrollment Specialist Certification (PESC); Certified Provider Credentialing Specialist (CPCS); and/or experience in provider enrollment, credentialing and or medical billing preferred
• Comprehensive knowledge of all participating payer policies and procedures and applicable regulations, to accurately complete and submit provider enrollment applications and changes to the SSH payers
• Effective verbal, interpersonal and written communication skills and ability to work independently, as well as in a team setting with internal and external constituents
• Strong attention to detail and quality, exceptional organizations and time management skills are essential to the success of this role
• Proficiency with Microsoft Office suite (MS Word, Outlook, Excel, and Adobe)