Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist

The starting rate for the position is $30.27 per hour but may go up based on experience.

The Credentialing & Enrollment Specialist is responsible for supporting the development and implementation of strategies and services which improve efficient and accurate health center revenue cycle operations and contribute to the financial sustainability of health center services. This position will work directly with health center staff and payer contacts, utilizing customer service skills to promote engagement in reaching improved outcomes related to credentialing, enrollment, and related activities.

Responsibilities and Duties

1. Works directly with health center staff to ensure efficient and accurate provider insurance credentialing and enrollment.
   1. Manages timely communications with health center staff related to insurance credentialing and enrollment requests, changes, additions, and terminations.
   2. Follows established processes and protocols to ensure successful and accurate completion and maintenance of provider insurance credentialing and enrollment tasks, which varies by payer.
   3. Ensures enrollment requests are processed by payers according to reasonable timeframes and reaches out to payer contacts to troubleshoot, as needed.
   4. Responsible for follow-up on notifications received from centers related to claim denials related to provider enrollment, incorrect PCP status of enrolled providers including reported patient inability to select desired PCP, and other related error resolution needs.
   5. Maintains accurate and timely documentation of activities, status updates, and other pertinent information.
2. Works directly with health center staff to promote health center engagement in services, trainings, peer learning, and other efforts which support efficient and accurate health center enrollment and credentialing, provider onboarding processes, and related activities that contribute to the financial sustainability of health center services.
   1. Supports the continued growth and improvement of enrollment and credentialing related contractual services offered to health centers.
   2. Supports the enrollment and credentialing related matters for Health Centers and MPCA staff by providing technical assistance, training, and education and ongoing support to health centers in assigned areas.
   3. Provides support to MPCA training events, network gatherings, resource development, webinars, and conference calls to support and strengthen health center enrollment and credentialing activities.
   4. Builds and maintains subject matter expertise in assigned areas to stay abreast of relevant changes in practice, policy, and evidence and infuses that knowledge into MPCA offerings.
   5. Works collaboratively with stakeholders to gather constructive input to continually improve the support provided by MPCA to health centers.
3. Other duties, as required.

Knowledge, Skills and Abilities

Knowledge of:

• Requires knowledge of healthcare provider onboarding functions, including provider enrollment, credentialing, CAQH and NPI updates, and privileging processes.
• Knowledge of Michigan's health coverage landscape including common public and private payers

• Word processing, spreadsheets, database software, and electronic communication technology
• Electronic health record and practice management systems

Skill/Ability to:

• Ability to assess problems, determine solutions and make decisions in a timely manner
• Ability to engage in relationship building and utilize customer service skills
• Ability to self motivate and take initiative to further organizational goals
• Ability to build credibility and trust with members and partners.
• Ability to develop and maintain productive partner relations.
• Ability to interpret relevant policies and procedures
• Works independent and as a team member with minimal supervision
• Ability to communicate complex and technical information in a clear and concise manner, both verbally and in writing.

Education/Experience:

• 3 years of professional experience working in revenue cycle, enrollment, credentialing, or other related work area in an outpatient healthcare setting required
• FQHC enrollment experience preferred; bachelor's degree preferred