Provider Enrollment Rep 1 job - Molina Healthcare - Augusta, ME

Assists Providers in a call center setting and interacts with internal departments on provider enrollment issues and updates. Provides maintenance to provider files as necessary.

Essential Functions

o Handles heavy inbound call volume.

o Assists providers via telephone to resolve issues or assist with changes related to their provider file.

o Updates provider changes, certifications and license updates in addition to taking calls.

o Navigates multiple licensing internet sites to obtain required verification on new enrollments and re-enrollments.

o Follows up with providers on outstanding issues within contractual guidelines set by our customer.

o Provides excellent customer service.

o Interacts with providers in a professional manner and knows when to elevate calls, and identifies the root cause.

o Meets and retains quality and production standards set by management.

State Plan / Department Specific Duties and Responsibilities

o Reviews all applications, provider requests and supporting documentation for accuracy and completeness and adds the information to the file according to policy, in a prompt, timely manner as directed per contractual guidelines.

o Ensures sanction checks are performed on all new enrollments, re-enrollments and change of ownership applications.

o Returns all rejected/denied applications/forms/correspondences with written documentation giving the reason for the rejection or denial.

o Assists with indexing as necessary.

Knowledge/Skills/Abilities

o Excellent organizational, and verbal and written communication skills

o Basic knowledge of Microsoft Office

o Ability to multi task in a high paced environment and retain information

o Ability to abide by Molina policies

o Ability to maintain attendance to support required quality and quantity of work

o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

o Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Job Qualifications

Required Education:
High School Diploma or equivalent GED

Required Experience:
2 years customer service/call center experience

Customer Service/Call Center Experience

Familiarity with Data Input

Basic knowledge of Microsoft Office

Required Licensure/Certification:
N/A

Preferred Education:
Preferred Experience:
Medicaid experience

Medical Claims experience

Provider Credentialing experience

Preferred Licensure/Certification:
N/A

Additional Description

To all current Molina employees if you are interested in applying for this position please apply through the

intranet

job listing.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.