Sentara Healthcare is currently Provider Data and Enrollment Specialist II

This is a Full-Time position with day shift hours and great benefits!

Remote opportunities available in VA, NC, GA, FL, TN,TX

Job Requirements:

BA preferred. Minimum of 3 years experience in healthcare insurance working with provider, network or contract data; or a combination of education and experience, which would provide an equivalent background

Understanding of health claims processing is a plus

High school diploma or equivalent

Microsoft office, Word, outlook email and calendars skills

Documentation Skills/ Data entry Skilled

Must be a team player and have great written and verbal communication skills

Member focused, customer service oriented, ability to work within a team environment

Primary responsibilities include:

Job Description Summary

The primary role of the Provider Data Enrollment Specialists is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider set up to initiate credentialing, provider record updates and edits, processing provider terminations and researching and resolving provider setup issues in the applicable systems. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.

Understanding of health claims processing is a plus

Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

The primary role of the Provider Data Enrollment Specialists II is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider set up to initiate credentialing, provider record updates and edits, processing provider terminations and researching and resolving provider setup issues in the applicable systems. This position is also responsible for remediating capitation related provider data issues and regulatory related research and updates .This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes.

• Insurance 3 years