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.

Assures compliance with all health plan requirements related to provider certification and credentialing.

Manages and monitors department activities to ensure compliance with policies/procedures and regulations.

Reviews and streamlines processes and workflows for the on-boarding department, using automation where appropriate.

Works with technical staff to develop tools and procedures for auditing and reporting, streamlining credentialing processes, and communicating with company and external stakeholders.

Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements.

Interacts effectively with varied levels of management, physician office staff, and physicians to accomplish credentialing and various implementation and launch elements.

Maintains up-to-date data for each provider in credentialing databases and online systems; ensures timely renewal of licenses and certifications.

Responsible for all audits to ensure that delegated credentialing entities are compliant.

Maintains confidentiality of provider information.

Assists in managing the flow of information between payers, contracted MSO facilities, and PMG.

Coordinates and prepares reports.

Records and tracks credentialing statistics.

Additional duties as assigned.

Requirements:

2+ years’ experience in managed care credentialing, billing, and/or Medical Staff service setting.

Demonstrated skills in problem-solving, analysis, and resolution.

Ability to function independently and possess demonstrated flexibility in multiple project management.

Complies with HIPAA rules and regulations.

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