- Process provider enrollment applications to ensure new and currently enrolled providers are within compliance within NC State regulations.
- Validate the qualifications of licensed professionals, organizational members or organizations
- Render a determination that an organization or entity meets the established qualifications, requirements and/or standards to provide a service or procedure as outlined in the State business rules/desk procedures.
- Perform and assess the background check through Lexis Nexis, AAR and PPTD.
- Perform source verification of licensure, certification, endorsements and accreditations through Lexis Nexis or State Licensure Board.
- Deny providers that do not meet the requirements.
- Meet performance quality standards on a daily basis.
- Meet performance quantity standards on a daily basis.
- QUALIFICATIONS:
- Knowledge of NC Medicaid or Healthcare
- Working knowledge of NCTracks.
- Working knowledge of provider enrollment requirements
- Proficient with Microsoft suite
- Desired Skills and
- Credentialing experience
- Customer service experience
- Experience working with fax machines, computer software, and telephone technology
- Attention to detail
- ATTRIBUTES FOR SUCCESS:
- Strong verbal and written communication
provider enrollment specialist ii - Raleigh, NC , USA, United States - NES Associates
Description
Type of Requisition:
Regular
Clearance Level Must Currently Possess:
None
Clearance Level Must Be Able to Obtain:
None
Suitability:
Public Trust/Other Required:
None
Job Family:
Healthcare Claims
Job Qualifications:
Skills:
Credentialing, Microsoft Word, Provider Enrollment
Certifications:
Experience:
1 + years of related experience
US Citizenship Required:
Yes
Job Description:
General Dynamics Information Technology created the premier provider of high-tech IT solutions to the government IT market.
Together as General Dynamics Information Technology, we deliver cost-effective, next-generation IT solutions and services to the Department of Defense, the intelligence community and federal civilian agencies as they modernize their information systems.
GDIT is currently seeking a Provider Enrollment Specialist II in Raleigh NC to join our team.In this role you will be a change agent by conducting operational audits and verifying that operational procedures are followed correctly for the Provider Enrollment Section.
This section is responsible for enrolling providers for the NC Medicaid Programs.This involves ensuring that providers are licensed and accredited for the services enrolling to provide and do not have a criminal background.
RESPONSIBILITIES:
Experience:
Scheduled Weekly Hours:
40
Travel Required:
None
Telecommuting Options:
Hybrid
Work Location:
USA NC Raleigh
Additional Work Locations:
We are GDIT.
A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S.
government, defense and intelligence community.Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation.
We operate across 30 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development.Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
We connect people with the most impactful client missions, creating an unparalleled work experience that allows them to see their impact every day.
From securing our nation's most sensitive systems, to enabling digital transformation and cloud adoption, our people are the ones who make change real.
GDIT is an Equal Opportunity/Affirmative Action employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.