Impress employers and recruiters.
Choose from hundreds of resume examples.

Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

The Provider Enrollment Specialist plays a vital role within the Payor Strategy team, managing and maintaining the enrollment and credentialing for Aspen Dental providers with insurance payers and assigned dental plans. This role ensures timely and accurate submission of provider applications, updates, and recredentialing to facilitate uninterrupted billing, reimbursement, and patient care.

Responsibilities

• Prepare, submit, and track payer enrollment applications for new providers and existing provider changes.
• Maintain accurate records of all enrollment activities in the credentialing system.
• Communicate with insurance companies, healthcare providers, and internal departments to ensure applications are processed efficiently.
• Monitor enrollment status and follow up with payers to resolve delays or issues.
• Update provider demographic and practice information with all contract payers as needed.
• Ensure recredentialing timelines and requirements are maintained so providers enrollment status remains intact with no lapses.
• Work closely with Field Support, Operations, and Revenue Cycle Management (RCM) team to resolve any escalated enrollment or credentialing issues in a timely manner.
• Research and resolve out-of-network claims issues by investigating provider participation status and effective dates of enrollment.
• Coordinate temporary provider enrollments and ensure all necessary documentation, linkage, and payer updates are completed.
• Collaborate closely with RCM on the status of provider enrollments, including providing reports submission as needed.
• Generate and maintain enrollment status reports.
• Support audits and other duties as assigned.

Requirements

• High school diploma or equivalent required.
• 1-3 years of experience in payor enrollment.
• Working knowledge of commercial payors and government payor requirements.
• Proficient in Microsoft Office and credentialing software including but not limited to CAQH, Availity.
• Strong attention to detail, organization, and follow-up skills.
• Excellent communication and customer service abilities interacting with internal teammates and external clients.
• Detail-oriented, with a strong level of analytical and problem-solving skills.

Skills

• Payor enrollment
• Commercial payors
• Government payor requirements
• Microsoft Office
• CAQH
• Availity
• Attention to detail
• Organization
• Follow-up skills
• Communication
• Customer service
• Analytical skills
• Problem-solving skills
• Multi-specialty large group practices
• Dentistry
• Revenue cycle
• Billing processes
• NPI
• File provider management

Location

• Remote

Work Type

• Remote
• Full-time

Experience Level

• 1-3 years

Education Level

• High school diploma or equivalent
• Associate degree preferred
• Bachelor's degree preferred

Salary/Compensations

• $24.00-26.00 per hour

Benefits

• Paid time off
• Health insurance
• Dental insurance
• Vision insurance
• 401(k) savings plan with match

About the Company

• The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 47 states in three distinct categories: Dental care, urgent care, and medical aesthetics.
• TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Lovet Pet Health Care and Chapter Aesthetic Studio.
• Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

Equal Opportunity

• If you are an applicant residing in California, please view our privacy policy here: https://careers.aspendental.com/us/en/tag-privacy-policy-for-california-employees
• View CA Privacy Policy