Provider Enrollment Specialist

Required Qualifications:

• High School Diploma/GED
• Requires 2 years administrative experience
• Knowledge of NC Medicaid or Healthcare
• Working knowledge of NCTracks
• Working knowledge of provider enrollment requirements
• Proficient with Microsoft suite
• Strong verbal and written communication

Desired Qualifications:

• Credentialing experience
• Customer service experience
• Experience working with fax machines, computer software, and telephone technology
• Attention to detail

Responsibilities:

• Process provider enrollment applications to ensure new and currently enrolled providers are in compliance with 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 accreditations 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.