T3COGNO Private Limited is a HR Services Company that offers end to end HR services and solutions to clients globally.
Provider Enrollment Specialist
Location
Texas
Posted
4 days ago
Salary
0
Seniority
Senior
Job Description
Provider Enrollment Specialist
T3Cogno
• Responsible for coordinating requests for participation in health insurance network as a medical provider • Monitoring and maintaining provider enrollment and re-enrollment process in a timely and compliant manner • Reviewing provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements • Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner • Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others • Maintains positive working relationships with providers • Plays an active role in explaining providers and practice/office managers the submission requirements for credentialing/recredentialing processes • Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc. • Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data • Proactively obtains updated provider credentialing data prior to expiration • Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions • Completes all additions, updates, and deletions • Supports new provider onboarding processes as related to enrollment • Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner • Fosters working relationships and teamwork with departments, vendors, etc. • Develops databases and spreadsheets for tracking organization providers • Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management • Continuously searches for process improvements to achieve accuracy and efficiencies • Performs other duties as assigned or required
Job Requirements
- California market experience is key
- Must have experience with Department of Labor enrollments
- Healthstream experience is preferred
- Prior experience with internal auditing is key
- CAQH experience is a plus
- High School Diploma or equivalent
- 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements
- Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools
- Motivated to quickly learn and demonstrate strong problem-solving skills
- Strong project management and multitasking skills
- Excellent interpersonal and communication skills
- Strong writing skills and attention to detail
- Strong organizational skills and ability to be attentive to details
- Demonstrated knowledge of healthcare contracts preferred
Benefits
- Joining comes with an array of benefits
- flexible work hours when possible
- genuine sense of belonging to a dynamic and growing organization
- Access to a 401(k) Retirement Savings Plan
- Comprehensive Medical, Dental, and Vision Coverage
- Paid Time Off
- Paid Holidays
- Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services
Related Guides
Related Categories
Related Job Pages
More General Jobs
Clinical Quality Specialist
SonderMindYour all-in-one wellness solution that connects you to affordable, quality mental healthcare
• Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care • Apply evidence-based UM criteria to evaluate clinical documentation and support authorization and appeal processes • Monitor care intensity and utilization trends to identify outliers and inform targeted provider interventions • Partner with health plans on external UR requests and peer-to-peer review coordination • Investigate and remediate provider concerns stemming from UM findings, client complaints, or external reports • Monitor clinical adverse events and apply early-stage risk mitigation in partnership with cross-functional teams • Support measurement-based care initiatives and identify opportunities to strengthen clinical outcomes across the provider network • Track utilization metrics, review volumes, and case outcomes to inform quality improvement efforts • Surface trends and process gaps to leadership and contribute to the ongoing refinement of UM policies and workflows
Summer High School App Development Intern
HideOut Youth ZoneProviding Manchester's young people with somewhere safe to go, something positive to do and someone trusted to talk to.
• Work with technical teen co-founders and professional developers to build Hideouts • Develop updates, improvements, and new features for mobile and web versions of Hideouts • Collaborate with a team of other interns
Summer High School Administrative Startup Intern
HideOut Youth ZoneProviding Manchester's young people with somewhere safe to go, something positive to do and someone trusted to talk to.
• assist with day-to-day administrative tasks needed to keep Hideouts running • work closely with teen co-founders on non-technical, clerical tasks • help with recruitment, various paperwork, and general coordination of company personnel • apply for grants or handling email correspondence with partners
• DOF is seeking expressions of interest for current and future job opportunities from highly experienced, skilled and knowledgeable Integrated Ratings (IR) with a (II/5 and III/5) certification and/or Crane Operator Stage 3. • These positions will ensure the safe and efficient operations on DOF Vessels by performing routine maintenance and repairs, operating specialised equipment and working under the direction of the Deck Officers and Engineering Officers. • IRs that work with DOF take pride in our assets and work to the highest standards to deliver safe and efficient operations to our clients.
