* Position is eligible for Remote / Work from Home opportunity *

Department: Provider Enrollment

Telecommuting Eligible: Yes

Job Grade: N11

Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.com)

Job Title

Provider Enrollment Representative I

Job Summary

The Provider Enrollment Representative I completes routine enrollment tasks in support of the provider enrollment team. This position researches and controls incoming applications and correspondence to ensure the work is properly categorized. This position reviews and processes a high volume of prospective provider enrollment applications

Key Performance Indicators

• Attention to detail and accuracy
• Strong interpersonal communication skills
• Organization, time management, and critical thinking skills

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Researches and controls incoming applications and correspondence to ensure work is properly categorized
• Enters data into internal document management and workflow systems
• Provides quality check on the provider enrollment data and enters application information into claims processing systems
• Manages inbound/outbound online FAX queues to and from providers
• Quality assurance checks of claims processing system enrollment data
• Creates and mails notification letters
• Completes application returns and/or application acknowledgement process
• Support other enrollment functions such as status calls, basic data entry, special mailings, etc.
• Reviews, researches, and processes provider enrollment applications abiding by contract regulations, internal policies, and guidelines
• Coaches providers through the enrollment process and provides inbound phone support
• Initiates requests for information to complete the online enrollment process
• Verifies credentialing information and completes fraud detection and prevention

Non-Essential Duties and Functions

• Supports team on special projects and assignments
• Other duties as assigned
• Special projects as assigned

Minimum Qualifications

• High School diploma or GED
• 6 months' clerical experience
• Advanced computer skills, keyboarding, and data entry skills
• Experience with computer programs such as: Microsoft Word, Excel, Access, Outlook and Share Point

Preferred Qualifications

Above requirements and the following:

• Knowledge of provider enrollment workload definitions, enrollment terminology, enrollment forms, and basic regulations, policies, and procedures
• Proficient in Microsoft Office Applications
• 12 months' provider enrollment experience

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
An employee in this position may be required to possess a “Federal Identification Card” (Federal ID) as a condition of employment. Federal ID’s may include one of the following: Personal Identity Verification (PIV) card, Personal Identity Verification-Interoperable (PIV-I) card, a Local-Based Physical Access Card issued by CMS, or a Local-Based Physical Access Card issued by another Federal agency and approved by CMS. Obtaining a Federal ID and continued eligibility for this position may require the successful completion of a Federal Background Investigation performed by the Federal Government and a residency requirement that you have lived in the United States at least three out of the last five years. Failure to obtain a Federal ID may result in the removal from the position or termination of employment.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Below is the salary range for potential new hires.
Salary Range: $17.20 – $20.60
Other Compensation: Self-Managed PTO (if applicable), Incentive Plan
Lifestyle Benefit: $50/month
This job will be closed 10/23/2024 at 8:00AM CST. No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)