Provider Enrollment Specialist

Provider Enrollment Specialist

• Location: Raleigh, NC
• Type: Contract
• Job #12644

DataStaff Inc. is seeking a Provider Enrollment Specialist for a contract-to-hire opportunity with one of our direct clients in Raleigh, NC.

• This position is Hybrid (In office 1 time per week)

Job Summary:

Drive better health outcomes for our clients as a Healthcare Claims Assistant II. Here, your work will impact many as you deliver healthcare expertise and services where they are needed most. Own this opportunity to advance not just research, but also your personal career growth. our client is currently seeking a Provider Enrollment Specialist II in Raleigh NC to join their team. 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. With our client, people are their differentiator. As a Healthcare Claims Assistant II, you will help ensure today is safe and tomorrow is smarter.

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 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.

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

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.

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