Credentialing & Enrollment Coordinator

Department: 13257 Enterprise Corporate - Managed Health Clinical insights & Operations: Credentialing

Status:

Full time

Benefits Eligible:

Yes

Hou rs Per Week:

40

Schedule Details/Additional Information:

Monday-Friday 8:30-5:00-Remote

Remote work is currently only approved for residents living in the following states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

Pay Range:

$24.10 - $36.15

Essential Functions

• Processes and submits complete, timely and accurate applications and rosters to the appropriate constituents directly.
• Interprets and assists in implementing the standards of the National Committee for Quality Assurance (NCQA).
• Maintain and audit credentialing software and data integrity and updates database accordingly.
• Processes requests and prepares correspondence to health plans through monthly communications.
• Serves as the first contact when communicating with practices and health plans regarding enrollment issues and directory listings.
• Performs health plan quarterly, semi-annual, and annual audits.
• Maintains current licensure, certifications, malpractice insurance, and any other applicable regulatory items at time of appointment and continuous maintenance going forward to ensure timeliness, accuracy and integrity of the credentialing database system and compliance with the regulatory agencies.

Skills: Must be tech savvy, a self-starter, detail oriented, and have solid critical thinking skills.

Physical Requirements
Performs most work under normal office conditions. Work may require sitting for long periods of time, standing, walking, using repetitive wrist/arm motion frequently and lifting.

Education, Experience and Certifications

High School Diploma or GED required; Bachelor's Degree preferred. Certification by National Association Medical Staff Services or Certified Provider Credentialing Specialists preferred. Previous experience as a Credentialing Coordinator or Provider Enrollment preferred. Knowledge of NCQA standards and guidelines.

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Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.