Credentialing & Enrollment Analyst I

Job Description

Job Description

Description:

Job Title: Credentialing & Enrollment Analyst I

Location: Remote, but must reside in any of the following states: AR, FL, IL, IN, KY, MO, OH, PA, or TN

Travel: N/A

FLSA Status: Exempt, Salaried

Work Schedule: Monday - Friday, 8:00 a.m. - 5:00 p.m.

About Family Allergy & Asthma:

Founded in 1979, Family Allergy & Asthma is one of the nation’s leading allergy and asthma practice groups, serving patients across Arkansas, Florida, Illinois, Indiana, Kentucky, Missouri, Ohio, Pennsylvania, and Tennessee. With more than 100 allergists, we are dedicated to delivering high-quality, patient-centered allergy and immunology care. Our comprehensive services include:

• Allergy and asthma evaluation and treatment
• Environmental, food, and drug allergy testing
• Pulmonary function testing
• High-risk food challenges
• Sublingual immunotherapy
• Aspirin desensitization
• Food immunotherapy

Position Summary:

The Credentialing & Enrollment Analyst I role involves daily management of credentialing & enrollment processes for providers (physician, nurse practitioner & physician assistants) that are employed by Family Allergy MSO. The analyst collaborates directly with the providers, insurance companies, hospitals, and other related healthcare entities to ensure that all necessary documents are maintained accordingly, submitted to the various entities and participation of the provider is approved and/or active. This role ensures providers meet all regulatory and compliance requirements to be reimbursed for services billed to the insurance carriers.

Summary of Duties & Responsibilities:

• Communicate with new provider to obtain documentation necessary for credentialing & provider enrollment processes.
• Create/Update required credentialing/enrollment portals.
• Medical Licensure – ensure active medical licensure respect to provider assigned regions.
• Board certification – ensure active board certification for related provider specialty.
• Malpractice – complete malpractice application, obtain signatures submit to contact.
• CAQH, Availity, CMS Systems – Update will all current accurate related data.
• Provider Enrollment – Insurance Plan Participation; Complete provider enrollment applications.
• Ensure timely follow-up procedures, throughout enrollment process.
• Complete re-credentialing and revalidations requests prior to deadlines, ensure re-approval is achieved.
• Hospital Privileges – Work in step with provider and hospital medical staff office completing application processes.
• Initial privileges – Complete applications for physicians.
• Re-Appointments – Complete reappointment applications.
• Dues and Application fees – Submit requests for payment to accounting via MyStampli system or pay by credit card.
• Excel Spreadsheets – Update various related excel sheets related to assigned providers such as Provider Credentialing; Provider Enrollment Tracker; Onboarding Checklist; Provider Insurance ID/PTAN; Hospital Affiliations; Provider NPI/License/DEA; Government Plan Revalidation; Standard Roster Templates; Current Locations; Malpractice; RCM Claims issues.
• Maintain active list of providers with medical society/board memberships and process related dues/fees yearly.
• Work shared email box with team members and respond or complete requests related to assigned providers.
• Reminder System – Notifications routed to team via HER-Medical Management system. Review daily and complete requests as required.
• RCM – Claims issues - assist in resolving claims issues that are provider enrollment related, which involves communication with the various insurance companies.
• Work notifications from RCM related to Checks from carriers being sent to wrong “pay to” address.
• Special Projects - complete any special assignments requested by Sr. Analyst or Payor Relations Manager.
• Other duties as assigned.

Abilities, Knowledge, and Skills:

Effective communication skills to include:

1. Ability to fluently speak and read English
2. Ability to read and interpret documents such as safety rules, handbooks, policies, and procedure manuals
3. Ability to communicate effectively, verbally and written, with all levels of staff and patients

Education:

• Required: High School Diploma or equivalent

Experience:

• Minimum of 2 - 3+ years of provider initiated “submission” level of provider enrollment and credentialing experience in any of the following states (AR, FL, IL, IN, KY, MO, OH, PA, TN).
• Florida credentialing & provider enrollment application experience preferred.
• Attention to detail and strong organizational skills.
• Knowledge of healthcare regulations & payor enrollment processes.
• Excellent communication skills (oral & written) to coordinate with providers, payers, medical staff offices, and other Family Allergy department team members.
• Proficiency in MS Office (Excel, Word, Outlook, TEAMS) & Adobe (edits, printing, saving, routing).
• Proficiency in various Payor portals (Availity, CAQH).
• Ability to work independently and manage multiple tasks with minimal supervision.
• Basic computer skills and understanding of modern office practices.

Physical Demands:

The physical demands described, here, are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the physical demands.

1. While performing the duties of this job, the employee is regularly required to use hands to handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.
2. The employee frequently is required to stand, walk, stoop, kneel, crouch, reach, push, pull, bend and sit. On average, injection room or clinic staff may be standing or walking 80% of their shift.
3. The employee must occasionally lift and/or move up to 30 pounds.
4. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
5. Specific communication abilities required by this job include the ability to talk and hear in order to converse with others, discern, convey, express oneself, and exchange information.

Work Environment:

The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job.

1. The noise level in the work environment is usually moderate; lighting is in the standard range.
2. The employee is subject to infectious waste, potential exposure to allergens in concentrated forms, diseases and conditions.

EEO Compliance:

All Family Allergy & Asthma divisions are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. Family Allergy & Asthma divisions are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice:

At Family Allergy & Asthma and all our divisions, our Human Resources department and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at Family Allergy & Asthma and our divisions. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

Pay Transparency:

To encourage pay transparency, promote pay equity, and proactively address regulations, Family Allergy & Asthma and all our divisions will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees. Salary offers may be based on key factors such as education and related experience.