Payor Enrollment Specialist (SC/NC/GA Remote only)

Remote: 
Full Remote
Contract: 
Work from: 

Offer summary

Qualifications:

Five years of experience in payor enrollment for Medicaid and Managed Care payors., Strong organizational skills and attention to detail are essential., A minimum of a High School Diploma or equivalent is required; some college or equivalent experience is preferred., Proficient in computer skills, particularly in Word and Excel. .

Key responsibilities:

  • Process credentialing and re-credentialing applications for health care providers.
  • Establish and maintain professional relationships with providers and insurance contacts.
  • Track and maintain credentialing information and provider files in the database.
  • Respond to requests for verification of provider credentials from hospitals and health payers.

Ob Hospitalist Group logo
Ob Hospitalist Group Large https://www.OBHG.com
1001 - 5000 Employees
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Job description

Position Summary: Processes credentialing and re-credentialing applications and Credentialing Vendor requests for OBHG health care providers.

Payor Enrollment Specialist Responsibilities:  Essential 

  • Maintain credentialing information by reviewing, entering and following up on missing
  • Establish and maintain professional relationship with providers, insurance providers, client contacts and account service/credential
  • Submit and follow up on request for signatures in a timely
  • Respond to credentialing
  • Contact and respond to request to/from hospitals and health payers for verification of provider's credentials, ensuring credentialing and licensing processes are completed
  • Responsible for the processing and preparation of the applications for insurance payer participation with the ability to manage multiple facilities'/payers' enrollment requirements, which includes non-application requests that are indicated by OBHG staff and/or facility/payer.
  • Track credentialing application
  • Maintains providers/practitioner files including maintenance of the OBHG provider database, individual CAQH profiles and providers rosters by identifying who may need updating or re­ credentialing and process
  • Maintains and updates CRM, Mail and Utility Logs for provider's licensure, board certifications and certificate of
  • Escalate non-responsiveness of MD to Supervisor with documentation of
  • Meet required turnaround times and accuracy
  • Ensure all Protected Health Information is kept in a secure location at all times and maintain Compliance by communicating credentialing request, status and issues to the Corporate Compliance
  • Participate in the credentialing committee as
  • Perform other duties as assigned by Payer Enrollment Manager and/or Management

Payor Enrollment Specialist Essential Skills/Credentials/Experience/Education

  • Five years’ experience in payor enrollment for Medicaid and Managed Care payors.
  • Strong organizational skills and attention to
  • A minimum of a High School Diploma or equivalent is required; some college or equivalent experience is preferred.

Preferred Skills/Credentials/Experience/Education

  • Strong telephone
  • Strong computer skills, proficient in Word, Excel &
  • Preferred understanding of medical
  • CPCS credentialing

Mental and Physical Demands (per ADA guidelines)

  •  Physical Demands: Sitting for long periods of Occupation requires this activity more than 66% of the time (2.6+ hrs/day)
  • Travel Demands: May require occasional travel to corporate headquarters in Greenville, SC

Hourly Compensation: $21.00 - $24.00 (based on experience)

What We Offer - The Good Stuff:

  • A mission based company with an amazing company culture.
  • Paid time off & holidays so you can spend time with the people you love.
  • Medical, dental, and vision insurance for you and your loved ones.
  • Health Savings Account (with employer contribution) or Flexible Spending Account options.
  • Paid Parental Leave
  • Employer Paid Basic Life and AD&D Insurance.
  • Employer Paid Short- and Long-Term Disability.
  • Optional Short Term Disability Buy-up plan.
  • 401(k) Savings Plan, with ROTH option.
  • Legal Plan.
  • Identity Theft Services.
  • Mental health support and resources.
  • Employee Referral program – join our team, bring your friends, and get paid.

Required profile

Experience

Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Organizational Skills
  • Detail Oriented
  • Microsoft Excel
  • Telephone Skills
  • Microsoft Word
  • Computer Literacy
  • Time Management
  • Teamwork
  • Communication

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