Remote Claims Specialist Jobs in Decatur, IL (NOW HIRING)

• California market experience is key
• Examples: MediCal; Blue Cross Blue Shield of California
• Must have experience with Department of Labor enrollments
• Healthstream experience is preferred
• Prior experience with internal auditing is key
• CAQH experience is a plus

Location: Fully remote role with expected work hours from 8:30 AM to 5PM CT Mon-Fri.

Summary Description: 

The Provider Enrollment Specialist will be responsible for coordinating the requests for participation in health insurance network as a medical provider, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliance manner with all government and commercial payors. They will also review provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements.

Job Responsibilities: 

• Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
• Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified. Maintains positive working relationships with providers.
• Plays an active role in explaining providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes.
• Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
• Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data.
• Proactively obtains updated provider credentialing data prior to expiration. Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions. Completes all additions, updates, and deletions. Supports new provider onboarding processes as related to enrollment.
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
• Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management.
• Continuously searches for process improvements to achieve accuracy and efficiencies.
• Performs other duties as assigned or required.

Skills and Education: 

• High School Diploma or equivalent.
• Experience in Radiology Payer Enrollment.
• 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements.
• Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools.
• Motivated to quickly learn and demonstrate strong problem-solving skills.
• Strong project management and multitasking skills.
• Excellent interpersonal and communication skills.
• Strong writing skills and attention to detail.
• Strong organizational skills and ability to be attentive to details.
• Demonstrated knowledge of healthcare contracts preferred

Company Benefits and Perks:

Joining  comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.

• Access to a 401(k) Retirement Savings Plan.
• Comprehensive Medical, Dental, and Vision Coverage.
• Paid Time Off.
• Paid Holidays.
• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.

If you are a dedicated and experienced Provider Enrollment Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at