Provider Enrollment Specialist
DataStaff Inc. is seeking a Provider Enrollment Specialist for a long-term contract opportunity with one of our direct clients in Raleigh, NC.
*This position is hybrid - Requires working in the office twice monthly
Job Summary:
In this role you will be a change agent by conducting operational audits and verifying that operational procedures are followed correctly for the Provider Enrollment Section. This section is responsible for enrolling providers for the NC Medicaid Programs. This involves ensuring that providers are licensed and accredited for the services enrolling to provide and do not have a criminal background.
Responsibilities:
- Process provider enrollment applications to ensure new and currently enrolled providers are within compliance within NC State regulations.
- Validate the qualifications of licensed professionals, organizational members or organizations
- Render a determination that an organization or entity meets the established qualifications, requirements and/or standards to provide a service or procedure as outlined in the State business rules/desk procedures.
- Perform and assess the background check through Lexis Nexis, AAR and PPTD.
- Perform source verification of licensure, certification, endorsements and accreditation's through Lexis Nexis or State Licensure Board.
- Deny providers that do not meet the requirements.
- Meet performance quality standards on a daily basis.
- Meet performance quantity standards on a daily basis.
Required Qualifications:
- Requires 2 years administrative experience
- Knowledge of NC Medicaid or Healthcare
- Experience working with fax machines, computer software, and telephone technology
- Proficient with Microsoft suite
Desired Qualifications:
- Experience with Lexis Nexis
- Credentialing experience
- Customer service experience
- Working knowledge of NCTracks.
- Working knowledge of provider enrollment requirements
- Strong verbal and written communication
- Ability to follow oral and written directions
- Attention to detail
This opportunity is available as a W2 position with a competitive benefits package. DataStaff offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months of employment.