Credentialing/ Provider Enrollment Specialist

Qualifications

• Must have at least 3 years of credentialing and office experience in a health care setting.
• Minimum of high school diploma or equivalent.
• Ability to work in a fast-paced environment while remaining organized and handling multiple priorities simultaneously.
• Ability to work with a small but dynamic HR team.
• Excellent communication skills and ability to build strong relationships with employees from new hires to executive management.
• Flexible with strong problem-solving skills.

Primary Functions

• Complete all credentialing and re-credentialing duties and applications for agency.
• Absorb full responsibility for maintaining, tracking and following up on any and all forms of licensure, certification, and credentialing documentation as required.
• Meet with all new hires with credentials or in the process of credentialing in order to get paperwork and licensure filed/requested with all insurance and funding sources.
• Work with finance to ensure all specified monetary increases/bonuses for employees with new credential qualifications are processed in a timely manner.
• Adhere to the credentialing requirements of all insurance/funding sources for which they qualify and provide Human Resources with the initial required documentation (licenses, liability insurance policies, DEA numbers etc.) and all renewals of these documents thereafter.
• Act as liaison between staff and insurance companies with regards to all credentialing correspondence.
• Work with billing team to ensure proper reimbursements are in place.
• Maintain up to date copies of staff licenses, certifications, DEAs, malpractice insurance and other provider information for credentialing and licensing.
• Attend Billing Team meetings to discuss any credentialing changes, updates or issues.
• Provide useful reports for management to be able to track where their staff are in the credentialing process.

Secondary Functions

• Weekly dedicated time for filing of confidential employee documentation into personnel files.
• Assist HR team with tasks and projects possibly including Open Enrollment, career fairs, etc.
• Participate on Training Committee and work to support CEU processing.
• Other HR duties as assigned.