* Instructions for applying.
(Read all information below first.)
1. If you have the skills and experience that match the job requirements then customize your resume accordingly to show you do.
(Provider Enrollment Team Lead has leadership, enrollment expertise, and compliance knowledge.)
2. Apply to the PACareerlink job posting.
3. Email your custom resume to thomas.lepera@montgomerycountypa.gov.
4. Your resume will be reviewed.
5. If you are a match to the position a special link with additional details will be emailed to you.
Provider Enrollment Team Lead - Location United States Category Medical Management and Quality Job Id 43994 Remote
Role Overview
Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Team Lead is responsible for reviewing large-volume provider requests for accuracy and coordinating with the supervisor on special project assignments to meet established timelines. The Team Lead also assists with training associates during and after formal onboarding while providing ongoing guidance and support to new hires, temporary staff, and contract agents.
Responsibilities
- Create, update, and maintain training materials, standard operating procedures (SOPs), bulletins, and online help resources.
- Review and assist associates with complex and high-risk provider requests and records, including sanctions, disciplinary actions, and cases where provider enrollment requirements are not met.
- Monitor workflow inventory to ensure requests are assigned appropriately and work is completed within established service-level agreements (SLAs).
- Research and analyze issues identified by clients or internal departments and recommend accurate, timely solutions. Serve as a liaison with internal and external stakeholders to troubleshoot and ensure efficient work processes.
- Complete departmental reports and logs as assigned. Communicate notifications, updates, and bulletins to all relevant departments.
- Participate in meetings and workgroups with internal and external departments to resolve provider-related discrepancies, claims issues, and other cross-functional concerns.
- Assist with mapping claims in the Invalid Provider Queue and support resolution of provider-related claim suspensions.
- Support the execution of panel transfer processes, panel releases, and primary care provider (PCP) assignments as needed.
- Perform additional duties as assigned to support the Supervisor and Manager.
Education and Experience
- Associate's degree preferred; equivalent work experience accepted.
- Knowledge of basic healthcare and managed care principles, as well as medical terminology, preferred.
- Minimum of 3 years of related experience in Provider Services, Claims, or Call Center operations.
- Minimum of 2 years of Provider Maintenance experience.
Skills & Abilities
- Proficiency with Microsoft Office applications (Excel, Word, Access).
- Strong verbal and written communication skills.
- Ability to plan, prioritize, and manage workload independently to meet deadlines.
- Proficiency with internal systems and applications used for provider data and workflow management (e.g., Healthcare System, LIFT, & Facets).
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 live 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
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AmeriHealth Caritas Services LLC