Salary: $15.00 - 16.72 per hour + Medical. Dental. Vision
Reference: 99882

Position Overview

The Provider Enrollment Representative is responsible for managing the enrollment, credentialing, and revalidation processes for healthcare providers with insurance networks, government payers, and other healthcare organizations. This role ensures timely and accurate submission of provider applications, compliance with payer requirements, and maintenance of current provider data to support smooth claims processing and reimbursement.

Key Responsibilities

Provider Enrollment & Credentialing

Prepare, complete, and submit provider enrollment applications for Medicare, Medicaid, and commercial insurance payers.
Maintain provider records in databases, including demographic information, licensure, certifications, and NPI details.
Coordinate with providers to collect necessary documentation and signatures for credentialing and re-credentialing.
Track and monitor application status, follow up with payers to ensure timely processing and approval.
Assist in resolving provider enrollment issues that impact claims, reimbursement, or network participation.

Data Management & Compliance

Enter and update provider information in credentialing or practice management systems (e.g., CAQH, PECOS, Availity, OneHealthPort).
Verify licenses, certifications, malpractice coverage, and other credentials to ensure accuracy and compliance.
Maintain organized digital and paper files of provider documentation and correspondence.
Ensure compliance with payer regulations, state/federal guidelines, and internal policies.

Communication & Coordination

Serve as the primary liaison between providers, internal departments, and insurance payers regarding enrollment and credentialing status.
Communicate updates, requirements, and next steps to providers and management in a timely manner.
Collaborate with billing, contracting, and credentialing teams to ensure provider readiness for claims submission.

Reporting & Administrative Support

Generate regular reports on application progress, approvals, expirations, and revalidation timelines.
Assist with audits, renewals, and updates as needed.
Participate in process improvement initiatives to streamline enrollment operations.

Qualifications

Education: High school diploma or GED required; associate’s or bachelor’s degree in business, healthcare administration, or related field preferred.
Experience:
- 1–3 years of experience in provider enrollment, credentialing, medical billing, or payer relations.
- Familiarity with Medicare, Medicaid, and commercial payer enrollment procedures.
Skills:
- Strong attention to detail and organizational abilities.
- Proficient with Microsoft Office Suite (Word, Excel, Outlook) and data management systems.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities and meet deadlines.
- Working knowledge of CAQH, NPPES, PECOS, and other credentialing portals preferred.

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity.

Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law.

JacksonvilleAFTEMP

Ascendo Resources jobs

Remote Provider Enrollment Rep