Credentialing & Payor Enrollment Specialist

Ensemble Health Partners · United States · 1 wk ago

RemoteRemoteHealthcare$19.75–$23.5/hrFull-time

O.N.E Purpose

Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity

Career Opportunity Offering: Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement

Pay and Schedule

This position pays between $19.75-$23.50 per hour based on experience
This role is remote, however, may require travel.

Responsibilities

Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire.
Maintains accurate provider records and makes edits to provider profiles.
Enters new providers and updates data, as needed.
Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates.
Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities, staying apprised of provider candidates’ statuses and alignment of tasks/goals as an individual and a team.
Serves as subject-matter-expert for providers with onboarding instructions and support.
Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results.
Develops relationships to achieve quality goals, implement best practices and redesign systems and processes.
Identifies gaps in client support/performance and proposes solutions (e.g. technology, services) to drive performance improvement.
Works collaboratively with team members to address new issues as they arise and responds promptly with acknowledgement or status.
Proficient use of various HIS and Enrollment Software.
Enters provider applications into payer portals for enrollment.
Demonstrates proficiency in the use of databases, CAQH, NPPES, Licensing Boards, and payer Web sites that will be used daily.
Verifies data for accuracy and completeness.
Responds to insurance payers’ requests for information in a prompt and professional manner.
Works as a team with outside vendors and facilities who share the goal of enrolling our providers.
Maintains confidentiality with providers’ personal information and upholds respect for privacy and regulatory requirements.
Provides excellent customer service.
Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility and alerts leadership to any potential risk regarding meeting deadlines, set standards or goals in place.

Qualifications

Job Experience: 1 to 3 Years
Education Level: High School Diploma, GED, or Equivalent
Experience Preferred
Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS)
Knowledge and understanding of State Medicaid Portals
Experience working with insurance enrollments, strongly preferred
Intermediate proficiency level in Excel
High level of attention to detail with the ability to solve problems and function independently
Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
Strong verbal and written communication skills
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Skills

Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS)
Knowledge and understanding of State Medicaid Portals
Experience working with insurance enrollments, strongly preferred
Intermediate proficiency level in Excel
High level of attention to detail with the ability to solve problems and function independently
Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
Strong verbal and written communication skills
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Benefits

Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

About the Role

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

Credentialing & Payor Enrollment Specialist

O.N.E Purpose

The Opportunity

Pay and Schedule

Responsibilities

Qualifications

Skills

Benefits

Company Information

About the Role

Similar jobs

Credentialing & Payor Enrollment Specialist

Credentialing Specialist (Payer Enrollment)

Payor Enrollment Specialist

Payor Enrollment Specialist

Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist