Provider Enrollment QA Specialist

• Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

• As a US Healthcare Provider Enrollment Quality Assurance Specialist, you will be responsible for ensuring the accuracy, completeness, and compliance of provider enrollment processes within a healthcare organization. You will play a critical role in maintaining high standards of quality and efficiency in provider enrollment activities to support the organization's revenue cycle management.

• Quality Assurance Oversight: Conduct thorough reviews and audits of provider enrollment applications, documents, and data to ensure accuracy, completeness, and compliance with regulatory requirements, payer policies, and organizational standards.
• Documentation Verification: Validate and authenticate provider credentials, licenses, certifications, and other required documents submitted during the enrollment process to ensure authenticity and compliance with regulatory and payer requirements.
• Application Processing: Facilitate the timely and accurate processing of provider enrollment applications, including data entry, verification, and submission to relevant regulatory bodies and insurance payers.
• Communication and Collaboration: Collaborate with internal stakeholders such as credentialing teams, provider relations, billing departments, and external parties including providers, insurance companies, and regulatory agencies to resolve enrollment-related issues, discrepancies, and inquiries.
• Policy Adherence: Stay updated on changes to healthcare regulations, payer enrollment guidelines, and industry best practices to ensure compliance and adherence to applicable standards in provider enrollment processes.
• Quality Improvement Initiatives: Identify opportunities for process improvement, efficiency enhancement, and quality enhancement in provider enrollment workflows. Propose and implement strategies to streamline processes, reduce errors, and optimize productivity.
• Training and Education: Provide training, guidance, and support to internal staff involved in provider enrollment activities to ensure understanding of policies, procedures, and compliance requirements.
• Reporting and Documentation: Maintain accurate records, documentation, and audit trails of provider enrollment activities. Generate reports, analyze data, and track key performance indicators to monitor compliance, identify trends, and support decision-making.

• Bachelor's degree in any related field.
• Minimum of 2-3 years of experience in healthcare provider enrollment, credentialing, or related areas. Experience in quality assurance, auditing, or compliance roles is highly desirable.

• In-depth understanding of healthcare regulations, accreditation standards, and payer enrollment requirements (e.g., Medicare, Medicaid, commercial insurers). Familiarity with enrollment software systems and databases is a plus.
• Strong attention to detail and accuracy in reviewing and verifying provider credentials, documents, and data.
• Proficiency in data analysis, problem-solving, and critical thinking to identify discrepancies, trends, and opportunities for improvement.
• Excellent verbal and written communication skills to effectively communicate with internal and external stakeholders, including providers, payers, and regulatory agencies.
• Ability to manage multiple tasks, prioritize workload, and meet deadlines in a fast-paced environment.
• Strong interpersonal skills and ability to work collaboratively as part of a team to achieve common goals and objectives.

Equal Employment Opportunity (Applicable only in the US)

Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Recruitment Agencies

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment

Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.

To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.