As a Credentialing and Enrollment Specialist, you will assist the team with initial credentialing and re-credentialing applications, agency applications for payer enrollment, submitting provider credentialing and enrollment applications to payers, maintaining accurate and current provider enrollment data in credentialing database and EMR, updating rosters with payers, auditing health plan directories, and a variety of other related tasks, as needed.


Specifically, you will:

• Pursue and Complete New Payer Contracts
• Verify Primary Source Verifications for Credentials
• Enroll Groups and Provider with Multi-State Medicare (PECOS), Medicaid, MCO, PPO
• Create and Update Providers CAQH profiles
• Create and Update Groups and Individual Providers Availity Profiles
• Credential providers with their appropriate SNF for Privileges
• Research and Complete Providers License Renewal requirements and applications
• Track new facilities list to update CAQH profiles
• Train team members

 

• Ensure accurate and timely submission of credentialing and enrollment applications with health plans
• Audit and update health plan directories for current and accurate agency and provider information
• Generate and maintain weekly and monthly reports of credentialing and enrollment processes
• Update credentialing and enrollment information in electronic health records software
• Responds to staff, provider, payer and other stakeholder inquiries and requests in a timely manner
• Process provider credentialing / re-credentialing applications and perform credentialing verifications
• Compile and maintain current and accurate data for all providers
• Set up and maintain provider information and documentation in credentialing databases
• Track license, certification, and professional liability expirations to ensure timely renewal
• Stay current on relevant state and federal regulatory requirements
• Maintain confidentiality of provider information and adhere to HIPAA guidelines/regulations
• Performs other duties as assigned

You'll be a good fit if you have:

• Minimum 2 year of experience in credentialing and knowledge of credentialing process required
• Experience with at least one credentialing software preferred
• Excellent attention to detail
• Ability to organize and prioritize tasks and manage multiple priorities under tight deadlines
• Ability to work independently with minimal supervision
• Proficiency with CAQH, NPPES, and PECOS
• Experience with NPPES/PECOS and Medicaid enrollment processes