Provider Enrollment Rep I

* Position is eligible for Remote / Work from Home opportunity *
Hiring Manager: Kathie Wokasch
Department: Iowa Provider Enrollment
Talent Partner: Elizabeth Fleming
Job Grade: N11
As a condition of employment, physical work location must be in one of the 50 states or the District of Columbia.

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Job Title
Provider Enrollment Representative I
Job Summary

The Provider Enrollment Representative I completes routine enrollment tasks in support of the provider enrollment team. This position researches and controls incoming applications and correspondence to ensure the work is properly categorized. This position reviews and processes a high volume of prospective provider enrollment applications
Key Performance Indicators

- Attention to detail and accuracy

- Strong interpersonal communication skills

- Organization, time management, and critical thinking skills

Essential Functions
Key Duties/Responsibilities/Accountabilities

- Researches and controls incoming applications and correspondence to ensure work is properly categorized

- Enters data into internal document management and workflow systems

- Provides quality check on the provider enrollment data and enters application information into claims processing systems

- Manages inbound/outbound online FAX queues to and from providers

- Quality assurance checks of claims processing system enrollment data

- Creates and mails notification letters

- Completes application returns and/or application acknowledgement process

- Support other enrollment functions such as status calls, basic data entry, special mailings, etc.

- Reviews, researches, and processes provider enrollment applications abiding by contract regulations, internal policies, and guidelines

- Coaches providers through the enrollment process and provides inbound phone support

- Initiates requests for information to complete the online enrollment process

- Verifies credentialing information and completes fraud detection and prevention

Non-Essential Duties and Functions

- Supports team on special projects and assignments

- Other duties as assigned

- Special projects as assigned

Minimum Qualifications

- High School diploma or GED

- 6 months' clerical experience

- Advanced computer skills, keyboarding, and data entry skills

- Experience with computer programs such as: Microsoft Word, Excel, Access, Outlook and SharePoint

Preferred Qualifications
Above requirements and the following:

- Knowledge of provider enrollment workload definitions, enrollment terminology, enrollment forms, and basic regulations, policies, and procedures

- Proficient in Microsoft Office Applications

- 12 months' provider enrollment experience

Environment and Cognitive/Physical Demands

- Office Environment

- Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve

- Requires prolonged sitting and telephone use

- Requires the use of office equipment such as computer terminals, telephones, copiers and printers

- Infrequent lifting to 15 pounds

- Infrequent stooping

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.
Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total Rewards Package