4550- Provider Services Specialist

About the Role

The Provider Services Specialist is responsible for the completion of enrollment tasks and the follow-up on credentialing-based holds and denials. The ideal candidate for the position follows the key performance goals as established by Caduceus for its client base of large-scale, multi-specialty healthcare organizations. The Provider Services Specialist is responsible for the escalation of new and existing : fielding, escalating, tracking, and trending payer, provider, or billing platform issues identified by his or her team and communicated to client and Caduceus management.

A Day in the Life

• Demonstrates a thorough knowledge and proficiency in all aspects of provider enrollment in a professional healthcare practice setting.
• Provides support on front end holds and back-end denials with a goal of follow up and resolution.
• Reports on new and existing issues to upper administration.
• Processes tasks from Enrollment Worklist including Credentialing Status, Payer Affiliation, Forms, and Online Enrollments. Assist with EDI, ERA, EFT, and Athena payor portal access
• Updates and maintains all Payer Enrollment groups and statuses as directed by lead or administration.
• Possess a working knowledge and effective navigation of  insurance portals including CAQH.
• Acts as liaison with Practitioners, billing management and insurance carriers.
• Performs other assigned du