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.

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.