Provider Enrollment Specialist at University Physicians' Association

Knoxville, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Jul, 26

Salary

0.0

Posted On

21 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider enrollment, Credentialing, Insurance carrier liaison, Database management, Data verification, Regulatory compliance, CMS regulations, NCQA standards, Excel, Word processing, Cactus software, Communication skills, Organizational skills, Attention to detail, Multitasking, Confidentiality

Industry

Hospitals and Health Care

Description

Description If you’re looking to build a rewarding career in healthcare within a supportive, growth-focused culture, University Physicians’ Association (UPA) would love to have you join our team. We are committed to creating a positive workplace where team members can learn, grow, and succeed—while enjoying a comprehensive and competitive benefits package. Why Join UPA? We offer an exceptional benefits package designed to support your professional and personal well-being, including: Remote work opportunities Flexible scheduling Casual work environment Paid, on-the-job training Medical, Dental, Vision, and Life Insurance Short-term & Long-term Disability Paid Time Off (PTO), Holiday Pay, and Sick Leave Onsite fitness center Employee Assistance Program (EAP) 401(k) with company match and immediate vesting This position offers the opportunity to work remotely following a required 90-day on-site training period in Knoxville, TN. Candidates must be able to commute to Knoxville during training. Schedule Full-time, Monday through Friday Typical work hours range between 7:00 a.m. and 5:30 p.m. Essential Functions Serve as a liaison between UPA clients and insurance carriers to ensure accurate provider enrollment and resolve large-scale issues Track and follow up on provider enrollment applications submitted to payers Communicate with payers regarding application status and document updates in the credentialing/enrollment database Maintain accurate provider data within UPA’s credentialing software and ensure timely updates with insurance carriers Perform quarterly provider data verifications for all UPA clients and as required by individual carriers Notify providers of upcoming license or malpractice insurance expirations Coordinate provider terminations with UPA providers and the Medical Staff Office as needed Participate in payer-delegated credentialing audits in accordance with NCQA requirements Attend and actively participate in staff meetings and quality audits Assist with the development and implementation of departmental policies, procedures, and forms Perform other duties as assigned Competencies Strong verbal and written communication skills Proficiency in Excel Excellent organizational skills with a high level of accuracy and attention to detail Ability to maintain professionalism and confidentiality Working knowledge of CMS, NCQA, and state and federal credentialing regulations Ability to multitask and manage complex responsibilities Flexible, collaborative, and team-oriented approach Self-motivated and able to work independently with minimal supervision Proficiency in Word processing and database systems; experience with Cactus preferred Ability to work effectively with diverse individuals and under varying circumstances Commitment to the values and mission of UPA and the Managed Care Department Requirements High School Diploma or GED required Minimum of two (2) years of experience in a healthcare delivery environment or one (1) to two (2) years of credentialing/enrollment experience

Responsibilities

The specialist serves as a liaison between clients and insurance carriers to manage provider enrollment applications and resolve related issues. They are also responsible for maintaining accurate provider data in the credentialing database and ensuring compliance with regulatory standards.