Full-Time Sr. Enrollment Specialist

• Assigns files to associates based on state and ensures that new groups are PAR by Go Live date and individual providers are PAR by Go Live date.
• Works with manager to ensure follow up and documentation is being completed in the CredentialStream system.
• Handles more complex issues relating to government or commercial payers.
• Ensures protocols are being followed to ensure timely resolution and completion of enrollment process so that provider files can be approved within 60 days from the date of a completed application.
• Attends JOCs with payers as required.
• Assures compliance with all policies and SOPs regarding timelines for submission.
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate.
• Oversees the file inventory and assigns files to associates to ensure timely completion of the credentialing process.
• Ensures all files are completed pursuant to the goal of 5 days from the date of approved credentialing, identifies issues, and escalates issues, as needed, to Manager and Director.
• Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
• Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements.
• Troubleshoots issues with files/providers and is the first point of escalation for issues for the team.
• Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Maintains confidentiality of provider information.
• Autonomously leads meetings with key internal and external stakeholders, including credentialing kick off calls with new care centers.
• Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
• Coordinate and prepare reports
• Record and track credentialing statistics
• Other duties as assigned.

• 3+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Demonstrated skills in problem solving and analysis and resolution
• Advanced Microsoft Excel skills
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• Must comply with HIPAA rules and regulations

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