Credentialing and Enrollment Specialist

About the role

The Credentialing and Enrollment Specialist is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained.

Primary Responsibilities

• Apply knowledge/skills to a range of moderately complex activities
• Demonstrate great depth of knowledge/skills in own function
• Sometimes act as a technical resource to others in own function
• Meet with Medical Director to review initial and reappointment applications
• Meet with AAAHC and State Auditors to review files
• Primary Source Verification Process for initial and reappointments
• Maintain Expirables for all employed and non employed clinicians at ASCs
• Compile and generate Credentialing Committee Minutes
• Perform internal audits on credentialing and re-credentialing files for accuracy and maintaining compliance with credentialing policies and procedures
• Maintaining knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate
• Monitoring upcoming renewal dates and working with medical staff to advise them on steps to maintain their credentials
• Proactively identify solutions to non-standard requests
• Solve moderately complex problems on own
• Work with team to solve complex problems
• Presentation skills to group setting
• Plan, prioritize, organize and complete work to meet established objectives
• May coordinate work of other team members
• Credentialing of medical group providers and hospital privileging application review and submission at the individual and group level
• Complete revalidation requests with govt and commercial payers
• Track and maintain medical professionals' licensure, certifications, etc.
• Work with other organizational departments internal/external to sure that credentialing efforts are in line with business objectives

Required Qualifications

• 3+ years of Healthcare Provider group/Facility Credentialing experience
• 2+ years of experience in healthcare administration, medical staff services, health information management
• 2+ years of experience with credentialing processes, medical staff privileging and knowledge of relevant software or databases used in credentialing
• Intermediate level of proficiency with Microsoft Excel and Word
• Ability to work Pacific time zone hours

Preferred Qualifications

• Experience working with Compliance Workflows and Processes including AAAHC, JC, CMS, and NCQA Policies
• Experience in researching and applying Government Regulatory Information
• Knowledge of CAQH
• Knowledge of MDStaff credentialing data base
• Data analytics
• Pecos enrollment
• Proven ability to plan and prioritize to meet benchmarks/deadlines

Schedule

Remote Nationwide. FT, 40 hrs. Monday - Friday, 8am - 5pm. You'll enjoy the flexibility to work remotely from anywhere within the U.S.

Pay

The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

Benefits

In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).