CREDENTIALING & ENROLLMENT SPECIALIST

Job Summary

The Credentialing & Enrollment Specialist is responsible for managing end-to-end processes of verifying healthcare provider qualifications and securing network participation with insurance payers. This team member will facilitate internal and external communications related to onboarding and revalidation activities, gather and organize pertinent information, and ensure all steps in the processes are completed efficiently and accurately.

Essential Duties / Responsibilities

• Coordinate credentialing activities for routine and ongoing onboarding initiatives
• Collaborate with internal teams to ensure smooth transition for new practices and providers
• Obtain and organize information and documentation pertinent to the acquisition of practices and providers
• Track status of onboarding activities and provide updates to internal departments
• Coordinate malpractice insurance certificates
• Document processes and procedures for credentialing activities
• Maintain and update databases for facilities and practitioners
• Maintain credentialing information database and ensure up-to-date information is available for internal departments
• Communicate with providers, medical office staff, licensing agencies, and insurance carriers
• Maintain our organization's payor matrix
• Provide support with payor contracts as required
• Participate in special projects and complete other duties as assigned

Required Skills / Abilities

• Compliance with all HIPAA policies
• Microsoft Office experience (Excel, Word, Outlook, PowerPoint)
• Excellent organization and communication skills
• Ability to handle multiple projects simultaneously in a fast-paced environment
• Satisfactory criminal background check

Education and Experience

• High School Diploma or equivalent; associate or bachelor's degree preferred
• 3+ years in the healthcare industry

Physical Requirements

• Ability to sit for extended periods while working at a computer
• Manual dexterity required for operating office equipment (e.g., computers, phones, fax machines)
• Ability to lift and carry up to 20 pounds occasionally
• Visual acuity is required to perform tasks involving computer screens and paper documents
• Ability to move around the office to access files, office machinery, and other equipment

This response is AI-generated, for reference only.