Provider Enrollment Specialist

Summary

Join ModMed's RCM BOOST team as a Provider Enrollment Specialist! Coordinate the application and enrollment process for physicians and providers, ensuring timely and accurate completion. Maintain enrollment schedules, communicate with providers and departments, clarify carrier requirements, and maintain confidentiality. Review client information, coordinate credentialing data, work with physicians to obtain documentation, obtain signatures, follow up with carriers, and respond to inquiries. This role requires strong organizational skills, attention to detail, and knowledge of medical billing, insurance policies, and regulations. The position offers a fast-paced environment within a growing healthcare IT company. ModMed is a top-rated company with a positive work environment.

Requirements

• Knowledge of medical billing, front-office, physician practice management, and healthcare business processes
• Must have strong organizational skills and be detail-oriented
• Working knowledge of medical insurance carrier policies and procedures, and State and Federal rules and regulations
• Excellent written, verbal, and interpersonal communication skills
• Working knowledge of Microsoft Office applications, especially Excel spreadsheets, and the ability to manage information located in multiple software systems
• Minimum of 3 years of previous experience required

Responsibilities

• Coordinates the application and enrollment process for new and existing physicians and providers
• Ensures applications are completed in a timely and precise manner
• Maintains the timelines on enrollment/credentialing schedules, communicates with providers and other departments to update as needed, clarifies carrier information requirements, and maintains a strict level of confidentiality for all matters pertaining to provider credentials
• Reviews new client packet information to determine any enrollment issues
• Coordinates credentialing data needed for enrollment and other related purposes
• Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment
• Obtains required client signatures and follows up with the carriers on documentation submitted
• Responds to internal and external inquiries on routine enrollment and contract matters

Preferred Qualifications

• Bachelor's degree preferred
• Medical Billing & Coding Certification is preferred

Benefits

• Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk
• Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees
• Allowances: Annual wellness allowance to support your well-being and productivity
• Earned, casual, and sick leaves to maintain a healthy work-life balance
• Bereavement leave for difficult times and extended medical leave options
• Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave
• Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind
• Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution
• 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep
• Generous Paid Time Off and Paid Parental Leave programs
• Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs
• Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed
• Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning
• Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles
• Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters