Provider Enrollment Specialist

Role Overview

The Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. This role also executes the panel transfer process, completes assigned projects, and interacts with internal and external clients regarding provider maintenance activities. Work Arrangement: Remote

Responsibilities

• Communicate provider changes to appropriate providers, members, and internal departments within required timeframes.
• Coordinate provider mailings for all claims in the invalid provider queue that cannot be processed due to missing or invalid information.
• Research and resolve returned checks and provider mail.
• Assist providers and internal customers by responding to and resolving all inquiries related to Panel Transfers, Panel Releases, and Special Needs PCP assignment processes.
• Complete department reports, logs, and documentation as assigned.
• Ensure all work is completed in accordance with service level agreements (SLAs).
• Attend required annual training sessions and maintain compliance with organizational standards.

Education & Experience

• Associate’s degree or equivalent work experience.
• Minimum of 1 year of related healthcare experience.
• Claims processing experience preferred.
• Knowledge of provider types and healthcare claims processes preferred.

Skills & Abilities

• Proficiency in Microsoft Office applications, including Word, Excel, Access, and Outlook.
• Experience with Facets software preferred.
• Strong attention to detail and organizational skills.
• Ability to communicate effectively with providers, members, and internal teams.
• Problem‑solving and analytical skills for resolving provider-related issues.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.

About AmeriHealth Caritas

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com