Provider Enrollment Specialist

How will this role have an impact?

This role will report to our Provider Enrollment, Delegated Credentialing Manager.

Responsible for reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. Responsible for accurate and timely processing of Part B provider enrollment applications.

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

What will you do?

• Ability to work within a deadline-intense environment.
• Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
• Plan, prioritize, organize and complete work to meet established objectives.
• Track and follow up with providers for timely return of all required documents and applications.
• Assists in synchronization of data among multiple systems
• Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing
• Prepare the CAQH application for newly affiliated and existing healthcare providers Maintains credentialing databases and ensures up-to-date tracking of file process.
• Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
• In-depth working knowledge of the various payer applications associated and the workflow process.
• Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.

We are looking for someone with:

• 3 years of experience in a centralized credentialing office and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
• Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
• Knowledge of Microsoft Word and other PC applications including preferred experience in a medical staff electronic database system, i.e. MD Staff.
• Knowledge of PECOS and State Medicaid Enrollment applications
• Knowledge of standards interpretation as related to NCQA

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved. 

Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.

We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.

To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.