NOW HIRING Provider Enrollment Specialist (Remote)
About Blue Cloud
- Blue Cloud is the largest pediatric Ambulatory Surgery Center (ASC) company in the country, specializing in dental restorative and exodontia surgery for pediatric and special needs patients under general anesthesia.
- We are a mission-driven organization committed to providing safe, high-quality, and accessible care while reducing costs for families and payers.
Our Vision & Values
- Our vision is to be the leader in safety and quality for pediatric dental patients treated in a surgery center environment.
- Our core values guide everything we do:
- We Cheerfully Work Hard
- We Are Individually Empathetic
- We Keep Our Commitments
Position Summary
The Provider Enrollment Specialist is responsible for managing provider and entity enrollments, recredentialing, and payer enrollment activities with Medicare, Medicaid, and commercial insurance plans. This role ensures timely and accurate enrollments, maintains provider records, resolves payer-related issues, and supports uninterrupted billing and reimbursement operations. The ideal candidate is highly organized, detail-oriented, proactive, and capable of independently managing a high-volume workload across multiple states.
Essential Duties & Responsibilities
- Facilitate initial enrollments, recredentialing, and payer enrollment applications for providers and entities with Medicare, Medicaid, and commercial insurance plans.
- Prepare, review, and submit enrollment applications, ensuring accuracy, completeness, and timely submission.
- Monitor enrollment application status and conduct proactive follow-up with payers to resolve issues and expedite approvals.
- Establish and maintain strong relationships with payer representatives.
- Document all payer communications and enrollment updates within the credentialing system.
- Maintain accurate provider and entity records, credentialing information, and enrollment data.
- Track enrollment, credentialing, and recredentialing deadlines to prevent interruptions in participation or reimbursement.
- Complete and submit EFT agreements and related payer documentation.
- Maintain and update provider information in payer directories and databases.
- Manage and maintain provider CAQH profiles, ensuring all information remains current and accurate.
- Collaborate with Revenue Cycle, Billing, Credentialing, Operations, and other internal stakeholders to address enrollment-related issues and questions.
- Provide enrollment status updates, reporting, and turnaround-time metrics to leadership.
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