Provider Enrollment Specialist (Full Time, Remote, North Carolina Based)

The Provider Enrollment Specialist ensures that all providers in the Alliance Health Network are enrolled in NCTracks with an active Medicaid Health Plan and a valid taxonomy for the service requested; reviews Provider Action Database to identify any providers for exclusion from the network.  Specialists will only approve applications for services identified as a network need and/or services mandated by compliance with Parity.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Responsibilities & Duties

Review, Respond, and Process all Provider Application Requests and Notice of Change Requests

• Monitor and respond to provider inquiries received via the Enrollment email Inbox and phone queue

• Review NC Tracks to confirm the following:
  • NPI enrollment
  • Site enrollment
  • Approved Taxonomy for service requested
  • Valid Health Plan enrollment

• Review Alliance Health Provider Action Database for provider exclusions
• Notify Contracts of approved additions and/or needed changes to contract 
• Complete written notice to providers regarding enrollment and contracting decisions per procedures
• Meet all identified turn around times for provider enrollment responses
• Verify that all NC Tracks information is reflected accurately in the ACS system based on the Provider Enrollment file
• Ensure that all departments that are affected by any enrollment changes are notified timely and according to policy and procedure

Track Provider  Applications Requests and Notices of Change

• Track  all provider requests and outcomes per department procedure

Minimum Requirements

Education & Experience

:

High school diploma/GED and six (6) years of experience in an administrative support role in healthcare

Or 

Bachelor’s degree from an accredited College or University and two (2) years of experience in an  administrative support role in healthcare. 

Preferred:

Behavioral Health experience preferred

Experience with NCTracks preferred. 

Two years experience in provider enrollment preferred.

Knowledge, Skills, & Abilities

• Knowledge of the organization and it’s functions
• Knowledge of NCTracks system
• Knowledge of computerized record-keeping techniques
• Knowledge of and experience with records, reports and file maintenance.
• Proficient with Microsoft Office suite
• Proficient with grammar, spelling, punctuation and vocabulary
• Skilled at organizing work to meet schedules and timelines
• Ability to communicate effectively both in oral and written form
• Ability to understand and follow oral and written directions
• Ability to exercise tact and discretion in working with confidential or sensitive information
• Ability to work independently with little direction
• Ability to establish and maintain effective working relationships with others
• Ability to analyze situations accurately and adopt an effective course of action

 Salary Range 

$23.36 - $29.78/ Hourly 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity 

 An excellent fringe benefit package accompanies the salary, which includes:   

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility