Provider Enrollment and Data Specialist



Advert ID




Job Type




Salary Range


No. of Openings


Branch Information

Honolulu, HI - (USA) 737 Bishop Street Suite 122 HI Honolulu , HI 96813

Branch Phone Number


Job Description


Supports enrollment and data submission efforts related to provider contracting and network participation. Responsibilities

include coordinating provider enrollment and maintenance activities in a centralized repository, timely provider updates for the claims processing system, contracting efforts for appropriate provider reimbursement, and assisting the department in achieving its goals and requirements for the provider network

Essential Duties and Responsibilities

· Supports enrollment and data submission efforts related to provider contracting and network participation.

· Receives inquiries from providers and employees via mail, email, telephone and fax. Replies to emails to

confirm receipt

· Analyzes incoming requests to determine the appropriate Provider Relations (PR) team member to which to

assign provider maintenance and contracting tasks. Provides initial direction to providers who are seeking to join

the network

· Coordinates the execution of provider agreements in preparation for network enrollment

· Initiates the fee negotiation process upon provider request

· Identifies providers who are terminating from a line of business (such as consulting) or from the network.

· Supports reporting requirements, ensuring timely submission of requested data and documentation.

· May assist in producing or providing data for weekly status reports for management review.

· Receives and routes incoming mail in a timely manner. Researches returned mail for proper distribution.

· Locates or provides copies of contracting files, fee schedules, and related documents during audits and as

necessary to complete research or respond to an inquiry.

· Generates Online for Providers registration and forgotten password communication as needed.

· Ensures processed contracting files, applications, provider correspondence, and related documents are properly

prepared for scanning in internal systems

· Handles incoming calls to the department's ACD phone line.

· Logs provider complaints, appeals, inquiries, and outcomes

· Assists with department projects


· Must comply with Company and Departmental policies and procedures.

· Performs other duties as assigned.

· Must be present in the office to perform job functions, except for external meetings and events.

· Job may be modified at any time

Education and Experience

High school diploma or GED is required. College degree in business or health care administration or related field; two

years of experience in provider services or in a physician's office; or equivalent combination is preferred.

Knowledge, Skill, and Abilities:


· Excellent customer service, organizational, time management and verbal and written

communication skills


· Strong attention to accuracy and detail

· Able to multi-task and work independently and in a team environment

· Read and interpret forms and documents such as applications and procedure manuals;

and write correspondence


· Maintain professionalism in stressful situations Required

· Intermediate-level proficiency in Microsoft Word and Excel Required

· Solve practical problems and interpret a variety of instructions furnished in written, oral,

diagram, or schedule form:


· Add, subtract, multiply, divide, and calculate figures and amounts

· Knowledge of the provider network management and credentialing requirements under

URAC's Health Network accreditation module

· Basic-level proficiency in Microsoft Outlook