4550- Provider Services Specialist

Ovii's Interpretation of the Role

The Provider Services Specialist drives provider enrollment, credentialing, and issue resolution for large multi‑specialty healthcare organizations. The role works remotely, liaising with practitioners, payers, and internal teams to ensure timely resolution of holds, denials, and billing platform problems.

Role Snapshot

• Manage provider enrollment and credentialing tasks
• Resolve payer, provider, and billing platform issues
• Liaise with practitioners, billing teams, and insurance carriers
• Maintain enrollment worklists and status dashboards
• Ensure HIPAA‑compliant handling of health data
• Support EDI/ERA/EFT and Athena portal access

Must-Have Requirements

• Athena experience
• Credentialing and enrollment experience (3+ years)
• HIPAA compliance knowledge
• Proficiency with Microsoft Office Suite
• Advanced knowledge of credentialing databases
• credentialing
• provider enrollment
• medical billing environment

Nice-to-Have Signals

• Bachelor’s degree or equivalent
• Multi‑specialty healthcare experience
• CAQH portal navigation
• EDI/ERA/EFT processing
• Strong written and verbal communication
• multi‑specialty healthcare

Work Setup

• Location: United States
• Work mode: REMOTE
• Remote scope: COUNTRY_RESTRICTED
• Remote countries: United States
• Employment type: Full-Time

Eligibility Gates

• Work authorization: Authorized to work in United States
• Visa sponsorship: no

Not Specified in JD

• Salary range
• Visa sponsorship
• Travel requirements
• Security clearance
• Coding test

What You'll Likely Work On

• Complete enrollment tasks and follow up on credentialing holds and denials
• Track, escalate, and trend payer or billing platform issues reported by the team
• Process items from the Enrollment Worklist, including credentialing status, payer affiliation, forms, and online enrollments
• Assist with EDI, ERA, EFT transactions and Athena portal access for payors
• Update and maintain payer enrollment groups and status reports as directed
• Act as liaison between practitioners, billing management, and insurance carriers
• Generate reports on new and existing issues for senior administration
• Demonstrate mastery of enrollment functions in testing environments

Good Fit If You Have

• Multi‑specialty healthcare experience is a strong plus
• Familiarity with CAQH portal navigation
• Ability to multitask under tight timelines with high attention to detail
• Excellent written and verbal communication skills