Highlights
The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Numbers & Facts
| Location | Newtown Square, PA |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
| Year Founded | 1985 |
| Website | http://www.amerihealthcaritas.com |
Description
Role Overview
The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. This role also executes the panel transfer process, completes assigned projects, and interacts with internal and external clients regarding provider maintenance activities.
Responsibilities
+ Communicate provider changes to appropriate providers, members, and internal departments within required timeframes.
+ Coordinate provider mailings for all claims in the invalid provider queue that cannot be processed due to missing or invalid information.
+ Research and resolve returned checks and provider mail.
+ Assist providers and internal customers by responding to and resolving all inquiries related to Panel Transfers, Panel Releases, and Special Needs PCP assignment processes.
+ Complete department reports, logs, and documentation as assigned.
+ Ensure all work is completed in accordance with service level agreements (SLAs).
+ Attend required annual training sessions and maintain compliance with organizational standards.
Education & Experience
+ Associate’s degree or equivalent work experience.
+ Minimum of 1 year of related healthcare experience.
+ Claims processing experience preferred.
+ Knowledge of provider types and healthcare claims processes preferred.
Skills & Abilities
+ Proficiency in Microsoft Office applications, including Word, Excel, Access, and Outlook.
+ Experience with Facets software preferred.
+ Strong attention to detail and organizational skills.
+ Ability to communicate effectively with providers, members, and internal teams.
+ Problem‑solving and analytical skills for resolving provider-related issues.
Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.
About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. This role also executes the panel transfer process, completes assigned projects, and interacts with internal and external clients regarding provider maintenance activities.
Responsibilities
+ Communicate provider changes to appropriate providers, members, and internal departments within required timeframes.
+ Coordinate provider mailings for all claims in the invalid provider queue that cannot be processed due to missing or invalid information.
+ Research and resolve returned checks and provider mail.
+ Assist providers and internal customers by responding to and resolving all inquiries related to Panel Transfers, Panel Releases, and Special Needs PCP assignment processes.
+ Complete department reports, logs, and documentation as assigned.
+ Ensure all work is completed in accordance with service level agreements (SLAs).
+ Attend required annual training sessions and maintain compliance with organizational standards.
Education & Experience
+ Associate’s degree or equivalent work experience.
+ Minimum of 1 year of related healthcare experience.
+ Claims processing experience preferred.
+ Knowledge of provider types and healthcare claims processes preferred.
Skills & Abilities
+ Proficiency in Microsoft Office applications, including Word, Excel, Access, and Outlook.
+ Experience with Facets software preferred.
+ Strong attention to detail and organizational skills.
+ Ability to communicate effectively with providers, members, and internal teams.
+ Problem‑solving and analytical skills for resolving provider-related issues.
Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.
About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
About Company
Leaders in health care solutions for those most in need
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.
Our mission, our goal
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.