Senior Provider Enrollment Representative

Company: Highmark Inc.

Job Description:

GENERAL OVERVIEW:

Join our dynamic team at Highmark Inc. as a Senior Provider Enrollment Representative, where you will play a vital role in managing provider enrollment and maintaining provider files across all service areas. You will be responsible for ensuring compliance with BCBS and CMS guidelines as well as various governmental regulations. In this position, you will process updates and modifications to provider information within our Provider File database, ensuring accuracy and timeliness in data management.

ESSENTIAL RESPONSIBILITIES:

Maintain precise data in provider file systems through various transactions, including:

Setting up and maintaining assignment accounts from submitted applications.

Updating group and provider affiliations based on incoming requests.

Processing updates for 1099 tax ID information, Medicare identifiers, and state licenses.

Making necessary demographic updates, such as name changes and specialty modifications.

Managing hospital and network affiliations, including terminations.

Conducting file maintenance and analysis to ensure data integrity.

Applying detailed guidelines in reviewing submitted requests for compliance.

Engaging with external sources like provider offices and state agencies to verify and collect necessary documentation.

Educating providers on acquiring and updating their identifiers as required.

Performing other related duties as assigned.

QUALIFICATIONS:

Minimum:

High School Diploma or GED.

5-10 years of related, progressive experience.

Language (Other than English): None

Travel Requirement: 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS:

Position Type: Office-based

This role involves direct interaction with team members and providers, and while physical work is required at times, lifting will not exceed 25 pounds.

Disclaimer: This job description outlines the essential roles and responsibilities expected of employees in this position but may not include all duties required.

Compliance Requirement: Employees must adhere to ethical and legal standards set forth by company policies and federal regulations.

Join us at Highmark, where we celebrate diversity and strive to create an inclusive environment for all employees!

Pay Range: $22.71 - $35.88 per hour, based on qualifications and experience.