Provider enrollment representative - united states, inverell

gainwell technologies llc

essential job functions

the credentialing/provider enrollment analyst will be responsible for supporting provider enrollment into the state of nevada medicaid program. responsibilities include reviewing and processing medicaid, provider enrollment applications according to nevada medicaid approved enrollment guidelines, aca, and other state and federal requirements and procedures. 

experience:
•    high school diploma or equivalent; may hold two year post-high school degree; may hold bachelor’s degree. 
•    minimum of two years working experience in a customer service role.  provider customer service preferred.
•    prior office or clerical experience.
•    experience working in healthcare, health insurance, provider enrollment, credentialing, or related fields is preferred. 
•    able to read, write and speak english proficiently.
•    basic understanding of utilizing a pc with windows and microsoft office experience. 
•    excellent written and verbal communication skills, including professional phone skills.     
•    positive completion of a nevada fingerprinting and federal background check. 
skills:
•    ability to perform work independently with limited support from leadership. 
•    ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines. 
•    self-motivated with good time management and organizational skills. 
•    ability to present themselves professionally in all interactions with the providers, client, etc.
•    problem solving skills.
•    high accuracy in completing tasks based on attention to detail. 
•    proficient, preferably knowledgeable, in ms outlook, ms word and ms excel preferred.      
•    ability to follow procedural guidelines.

responsibilities:
•    use multiple websites to screen and make determinations about meeting state requirements.
•    perform and document outreach to providers through phone calls and emails to ensure the provider includes all necessary and accurate documentation to complete enrollment. 
•    work directly with the client, division of health care finance and policy (dhcfp), as needed to review, and obtain necessary approvals on applications and updates.
•    update and maintain accurate provider files which includes documenting information such as license, social security numbers, tax id numbers, and any other changes to the provider file.
•    manage multiple tasks and be able to function within established timelines with minimal supervision.
•    conduct research to resolve provider issues or inquiries independently, while escalating more complex questions or issues appropriately.  
•    develop understanding of nevada medicaid and applies knowledge to support efficient procedures and adherence to service level agreements. training will be provided. 

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