Overview
Provider Enrollment Specialist (remote)
Pay Range: $72,000 – $100,000 / year
Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.
Benefits Information:
We are proud to offer best-in-class benefits and programs to support employees and their families in living healthy, happy lives. Our pay and benefit plans have been designed to promote employee health in all respects – physical, financial, and developmental. Depending on whether it is a part-time or full-time position, some of the benefits offered may include:
Day 1 Medical, supplemental health, dental & vision for FT employees who work 30+ hours
Best-in-class well-being programs
Annual, no-cost health assessment program Blueprint for Wellness®
healthyMINDS mental health program
Vacation and Health/Flex Time
6 Holidays plus 1 “MyDay” off
FinFit financial coaching and services
401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
Employee stock purchase plan
Life and disability insurance, plus buy-up option
Flexible Spending Accounts
Annual incentive plans
Matching gifts program
Education assistance through MyQuest for Education
Career advancement opportunities
and so much more!
Manage, monitor and complete activities related to Provider Enrollment applications, revalidation updates and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers, for Quest, Diagnostics, its subsidiaries, joint ventures and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.
Responsibilities
Review, prepare and submit requests for Medicare, Medicaid, and Health Plan payers to include completion of but not limited to: provider enrollment applications, revalidation requests, NPI enrollments, licensure updates, CAQH physician credentialing, health plan credentialing, attestations, and disclosures of ownership
Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations and Optum to successfully complete enrollment requests and related activities
Engage with payers directly to discuss enrollment issues, inquiries, updates and due dates of enrollment applications
Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer defined enrollment/re-enrollment deadlines
Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and eSignature tools
Other duties as assigned
Qualifications
Required Work Experience:
3 + years’ relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
Relevant experience in large, complex organizations, commercial lab, or healthcare organizations
Skills:
Strong analytical and problem-solving skills
Strong interpersonal skills; ability to work with external clients and multiple levels internal
Ability to handle confidential or sensitive information with discretion
Strong written & verbal communication
Strong attention to detail
Strong technical skills in MS Word and Excel
Able to multi-task and perform in a fast-paced environment
Lominger’s Competencies:
Customer Focus
Organizational Savvy
Learning on the Fly
Problem Solving
Dealing with Ambiguity
Drive for Results
Education:
Bachelor’s Degree preferred
EEO
Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.
Quest Diagnostics
You must sign in to apply for this position.