Provider Enrollment & Credentialing Specialist

Primary Responsibilities

• Accountable for the accuracy and timeliness of the entire process of obtaining, reviewing, submitting and tracking provider application, recredentialing and change paperwork
• Expedites information gathering by working with individual clinicians as well as specialty administrators, chiefs and/or medical directors
• Serves as liaison to physician recruitment and clinical practice supervisors/managers on matters related to credentials, licensure, hospital affiliations and provider numbers for assigned areas
• Facilitates, tracks and follows through with paperwork needed for clinicians to obtain initial hospital privileges (appointments)
• Responsible for tracking license, DEA, malpractice face-sheet and other certification renewals as well as keeping current copies on file
• Performs self-audit on credentialing work to assess quality, service and performance of end product to minimize the back and forth or phone calls from providers, payors and hospitals
• Conducts proactive audits and system reviews to ensure the accuracy of provider information in all systems (e.g., data on Atrius Health website, credentialing database, credentialing fields in Resolute)
• Reviews and monitors standard reports to communicate back to the sites regarding enrollment of providers under the specialist's jurisdiction
• Identifies areas of redundancy or areas that need to be standardized or streamlined vis a vis the payors, hospitals or changing industry standards
• Bridges issues to attention of supervisor and may make recommendations on improvements
• Reports to specialty and practice location when clinicians are credentialed and entered into the appropriate system/s for scheduling and billing
• Maintains complete and up to date credentialing file for all providers that require credentialing
• Interacts with internal departments to ensure systems have the proper insurance information and that clinician credentialing is aligned with the terms of the payor contracts
• Develops and builds collaborative relationships to handle queries or verifications, expedite processes and ensure clinician status changes are updated in an appropriate, timely fashion

Required Qualifications

• High School Diploma/GED
• 2+ years of credentialing/payer enrollment experience in a health plan or medical staff services setting
• Intermediate level of proficiency with Microsoft Office applications including Excel and Word

Preferred Qualifications

• Bachelor's Degree in Health Care Administration or related field preferred
• National Certified Provider Credentialing Specialist Certification preferred
• Previous experience with MD Staff credentialing database

Soft Skills

• Proven ability to manage and process detailed information
• Successful candidate must possess excellent organizational and communication skills, both written and oral and must also display well-developed interpersonal skills in order to work successfully with all levels of management and staff both internally and externally
• Strong attention to detail and accuracy
• The ability to work independently is also required

Working Conditions/Physical Demands

• Busy office environment with frequent deadlines and interruptions

Pay and Benefits

• Hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment
• We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)
• No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives