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Provider Enrollment Specialist
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- Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, resolving provider related issues for claims suspended to Provider Enrollment.
- Executes the panel transfer process.
- Communicates notification of changes to appropriate providers, members and other departments within the contracted time frame.
- Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
- Assists provider and internal customer by responding to and resolving all request and inquiries related to the Panel Transfers, Panel Releases, & Special Needs PCP assignments process.
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