Provider Enrollment Specialist, Local Candidates Remote Option Available

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Provider Enrollment Specialist ensures that initial and re-credentialing applications for St. Luke's University Health Network (SLUHN) employed providers' are submitted to identified third party and government health insurance carriers. Responsibilities also include maintaining membership and renewal information for professional and DEA licenses, board certification and professional organization memberships.

• REMOTE OPTION FOR LOCAL CANDIDATES at the discretion of management.

Job Duties And Responsibilities

• Identifies and communicates current or potential enrollment issues that could result in loss of revenue and/or patient dissatisfaction.
• Makes and receives phone calls from providers and practice managers to help resolve payer issues and verify participating status.
• Creates check requests for out-of-state enrollment fees.
• Participates in team meetings and conference calls with payers.
• Ensures SLUHN billing department has resolution on enrollment issues that assist with claim processing.
• Creates and submits new group enrollment applications for newly opened or moving practices. Fields and responds timely to inquiries from SLUHN departments to help resolve enrollment related issues.
• Updates & maintains database to show enrollment tracking, effective dates, provider numbers and correct provider demographics.
• Prepares provider enrollment applications and/or written link letters to be sent to payers
• Ensures all providers and groups are re-validated with payers on a timely basis by completing re-credentialing applications with current provider information and signatures.
• Scans and files all paperwork and documents to a shared folder for tracking purposes and proof of submission to payers.
• Completes online applications for Doing Business As (DBA) for new or renamed groups.
• Applies for New Jersey licensure for identified providers.

Physical And Sensory Requirements

Requires sitting for up to eight hours per day, including extensive use of computer terminal and telephone. Requires hearing as it relates to normal conversation and answering questions in large groups. Requires seeing as it relates to general near and far vision.

EDUCATION

High School Education

Training And Experience

Experience with personal computers and the Microsoft Office suite of products is required. Strong customer service skills. Excellent verbal and written communication skills. Detail and service oriented.

SCHEDULE

Full time position.

Training is in-house for a month or more at St. Luke's Center, Allentown, PA. Then, to a hybrid model: Monday and Friday at home.

Tues/Wed/Thurs is in the office with the team at St. Luke's Center, Allentown, PA.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.