Provider Enrollment Specialist (Full Time, Remote, North Carolina Based) (Healthcare)
The Provider Enrollment Specialist ensures that all providers in the Alliance Health Network are enrolled in NCTracks with an active Medicaid Health Plan and a valid taxonomy for the service requested; reviews Provider Action Database to identify any providers for exclusion from the network. Specialists will only approve applications for services identified as a network need and/or services mandated by compliance with Parity.
This position is fulltime remote. Selected candidate must reside in North Carolina. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed.
Responsibilities & Duties
Review, Respond, and Process all Provider Application Requests and Notice of Change Requests
- Monitor and respond to provider inquiries received via the Enrollment email Inbox and phone queue
- Review NC Tracks to confirm the following:
- NPI enrollment
- Site enrollment
- Approved Taxonomy for service requested
- Valid Health Plan enrollment
- Review Alliance Health Provider Action Database for provider exclusions
- Notify Contracts of approved additions and/or needed changes to contract
- Complete written notice to providers regarding enrollment and contracting decisions per procedures
- Meet all identified turn around times for provider enrollment responses
- Verify that all NC Tracks information is reflected accurately in the ACS system based on the Provider Enrollment file
- Ensure that all departments that are affected by any enrollment changes are notified timely and according to policy and procedure
Track Provider Applications Requests and Notices of Change
- Track all provider requests and outcomes per department procedure
Minimum Requirements
Education & Experience
Required:
High school diploma/GED and six (6) years of experience in an administrative support role in healthcare
Or
Bachelor's degree from an accredited College or University and two (2) years of experience in an administrative support role in healthcare.
Preferred:
Behavioral Health experience preferred
Experience with NCTracks preferred.
Two years experience in provider enrollment preferred.
Knowledge, Skills, & Abilities
- Knowledge of the organization and it's functions
- Knowledge of NCTracks system
- Knowledge of computerized record-keeping techniques
- Knowledge of and experience with records, reports and file maintenance
- Proficient with Microsoft Office suite
- Proficient with grammar, spelling, punctuation and vocabulary
- Skilled at organizing work to meet schedules and timelines
- Ability to communicate effectively both in oral and written form
- Ability to understand and follow oral and written directions
- Ability to exercise tact and discretion in working with confidential or sensitive information
- Ability to work independently with little direction
- Ability to establish and maintain effective working relationships with others
- Ability to analyze situations accurately and adopt an effective course of action
Salary Range
$22.90 to $29.19/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
Education
Required- High School or better in General Studies
Skills
Required- Communication
- Microsoft Office
- Organizing
- Tact
- Time Management
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
