Full-Time Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist will be the primary contact for the Enrollment Department for all provider credentialing, re-credentialing, and privileging processes.

Responsibilities:

1. Assures compliance with all health plan requirements for provider certification and credentialing.
2. Manages and monitors departmental activities to ensure compliance with policies, procedures, and regulations.
3. Reviews and streamlines processes and workflows for the on-boarding department, using automation where appropriate.
4. Works with technical staff to develop tools and procedures for auditing and reporting, streamlining credentialing processes and communication.
5. Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements.
6. Interacts effectively with varied levels of management, physician office staff, and physicians to accomplish credentialing and implementation/launch.
7. Maintains accurate data for each provider in credentialing databases and online systems; ensures timely license and certification renewals.
8. Audits delegated credentialing entities to ensure compliance.
9. Maintains confidentiality of provider information.
10. Manages the flow of information between payers, contracted MSO facilities, and PMG.
11. Coordinates and prepares reports.
12. Records and tracks credentialing statistics.
13. Performs other duties as assigned.

Qualifications:

• 2+ years’ experience in managed care credentialing, billing, and/or Medical Staff services.
• Demonstrated skills in problem-solving, analysis, and resolution.
• Ability to function independently and possess flexibility in multiple project management.
• Complies with HIPAA rules and regulations.

Salary: $45,000.00 - $55,000.00 (base pay, not including benefits or bonus). 10% annual bonus target possible.

Remote Work Requirements (if applicable): Minimum internet speed of 5 Mbps download and 3 Mbps upload.

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