Provider Enrollment/Credentialing Specialist

DESCRIPTION:

This position will be responsible for credentialing new and established health care providers, and maintenance of information to include application completion, follow up, data collection, data entry, and document review. Depending on the skill set and experience of the candidate selected, there may also be the opportunity to perform billing duties.

RESPONSIBILITIES:

• Collect, update and maintain necessary provider information and documentation and verify the information where possible.
• Establish and maintain data entry in CAQH.
• Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner.
• Verify provider and group information with insurance companies (addresses, provider rosters, contracted plans, provider numbers, etc).
• Coordinate information for enrollment and terminations of all providers.
• Maintain good rapport and professional communication with Health Plan Representatives.
• Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states.
• Build strong working relationships with medical facilities and provider offices.
• Adhere to department policies and procedures including timely delivery of completed work and use of resources.
• Responsible for entering, updating, maintaining NPI and any other applicable provider numbers.
• Provide concise, timely communication to appropriate leadership regarding potential credentialing issues.
• Proactively share knowledge with colleagues.
• Perform analysis and appropriate follow-up of each initial application and reappointment.
• Work with physicians, professional staff and physicians' office staff to acquire necessary materials and information.

QUALIFICATIONS:

• High school diploma or equivalent
• Minimum 3 years of credentialing experience
• Billing knowledge and experience preferred
• Prior experience with FQHC and Behavioral Health necessary.
• Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances
• Working knowledge of Availity, PECOS, etc. is required.
• Proficiency in MS Office, primarily Word, Outlook, Excel
• Excellent interpersonal skills to communicate with medical staff, providers and clients
• Detail orientation 
• Ability to abide by HIPPA standards and requirements
• Ability to multi-task
• Ability to work as a team player
• Ability to handle confidential information in a professional manner
• Willingness to take on new tasks and responsibilities
• Capable of taking the initiative to accomplish tasks
• Strong time management and organization skills
• Excellent problem solving and decision-making abilities

PHYSICAL DEMANDS:

• Work may require sitting for long periods of time.
• Operating a computer, keyboard, telephone, fax, or other such office equipment through a normal business day.
• Vision must be correctable to 20/20 for viewing information on computer screen and reading information in a paper format.
• Hearing must be in the normal range for telephone contacts.
• Will require viewing computer screen and typing on a keyboard for prolonged periods of time.