Provider Enrollment Specialist II - GHI / NGPG - Remote - Must live in Georgia - Mon - Fri 8:00am - 5:00pm

About the position

The position involves performing complex functions related to the enrollment of practitioners in Governmental and Commercial plans at Northeast Georgia Health System. This includes processing applications for Medicare, Medicaid, and Managed Care payors, as well as ensuring timely communication of pertinent information to relevant parties. The role requires a solid understanding of provider enrollment, credentialing, and managed care operations, relying on experience and judgment to accomplish daily tasks effectively.

Responsibilities
• Enroll Physicians and mid-level Providers in commercial and government payor plans including Tricare and Medicaid CMOs.
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• Prepare and submit provider enrollment and re-enrollment applications for NGPG Physicians and mid-level providers.
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• Complete requests for re-credentialing purposes and facilitate timely completion of applications with providers and Practice Managers.
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• Verify supporting documents for enrollment are received and completed correctly.
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• Monitor provider non-compliance with enrollment requests and notify management of delays.
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• Prepare and submit monthly delegated rosters to payors to ensure timely effective dates for billing and payment purposes.
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• Track monthly timeliness of provider loads by payor and report non-compliance to management.
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• Audit provider loads for accuracy and report errors to payors and management.
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• Ensure completion of various applications and processes for enrollment purposes.
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• Follow-up on rejected documents from payors and resubmit on a timely basis.
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• Maintain orderly and secure files for enrollment documents and correspondence.

Requirements
• High School Diploma or GED required.
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• 3 to 5 years of experience in Provider Enrollment, credentialing, or provider relations in a healthcare setting.
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• Experience working with Medicaid, Medicare, and other governmental payors in enrolling providers.
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• Knowledge of NCQA accreditation standards for credentialing providers.
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• Strong organizational and computer skills with attention to detail.
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• Excellent written and verbal communication skills.
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• Ability to handle multiple projects and establish priorities under deadline pressures.

Nice-to-haves
• Bachelor's Degree preferred.

Benefits
• Opportunities for professional development and growth.
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• Supportive work environment focused on community health improvement.

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