Provider Data and Enrollment Specialist I

City/State

Richmond, VA

Overview

Work Shift

First (Days) (United States of America)

• Sentara Healthcare is currently Provider Data and Enrollment Specialist I 

  This is a Full-Time position with day shift hours and great benefits!

  Remote opportunities available in VA, NC, GA, FL, TN,TX

  Job Requirements:

  1 year Health care /health plan

  High school diploma or equivalent

  Microsoft office, word, outlook email and calendars skills

  Documentation Skills/ Data entry Skilled

  Must be a team player and have great written and verbal communication skills

  Member focused, customer service oriented, ability to work within a team environment

  Primary responsibilities include:

  
  Job Description Summary

  The primary role of the Provider Data Enrollment Specialists is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider set up to initiate credentialing, provider record updates and edits, processing provider terminations and researching and resolving provider setup issues in the applicable systems. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.

  Understanding of health claims processing is a plus

  
  Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

  Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

  With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

  Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

  Our success is supported by a family-friendly culture that encourages

  community involvement and creates unlimited opportunities for development and growth.

  Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Job Summary

The primary role of the Provider Data Enrollment Specialists I is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider set up to initiate credentialing, provider record updates and edits, processing provider terminations and researching and resolving provider setup issues in the applicable systems. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.

Qualifications:

HS - High School Grad or Equivalent (Required)

Insurance

Skills

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.