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 expirable 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

• High School Diploma/GED
• 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 privilege 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 MD Staff credentialing databases
• Data analytics
• Pecos enrollment
• Proven ability to plan and prioritize to meet benchmarks/deadlines

Pay

The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment.

Schedule

FT, 40 hrs. Monday - Friday, 8am - 5pm. Remote Nationwide with the flexibility to telecommute from anywhere within the U.S.