Provider Enrollment Specialist (Full-Time, M-F)

Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the area’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Health Partners is a membership-driven physician-hospital organization (PHO) that exists to deliver contract management and other advocacy services for healthcare professionals.

Position Summary

The Provider Enrollment Specialist reports directly to the Health Partners Credentialing Manager. This position serves in a crucial role in coordinating, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. This position facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, tracking, and monitoring. This position assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement.

Essential Position Responsibilities

• Enroll each new provider into the selected health plans by submitting the required documentation to the designated payor contacts.
• Submit provider changes and terminations to all selected health plans to the designated payor contacts.
• Track provider loading completion for each payor and follow up on loading discrepancies or inaccuracies.
• Maintain accurate rosters for all health insurance payors and submit payor rosters at designated intervals or upon request of a specific payor.
• Track health insurance plan participation for all providers. 
• Serve as point-of-contact for enrollment status inquiries. 
• Notify provider designated representative of loading completion and the respective dates for each payor.
• Resolve any claims disputes resulting from provider enrollment and loading issues.