Payer Enrollment Specialist

Job Description

Job Description

Healthcare 

Provider Enrollment/Credentialing Specialist

Company: V2V Management Solutions

Location: 5598 N Eagle Rd, Ste 102, Boise, ID 83713

Pay: $30.00 - $40.00 per hour

Job description:

Seeking an experienced Provider Enrollment/Credentialing Specialist to support a busy and dynamic healthcare consulting firm. Our firm specializes in working with medical practices across the United States. We are looking for an experienced individual to join our busy Provider Enrollment team. The ideal candidate not only understands provider enrollment and credentialing but has experienced the full revenue cycle function would be beneficial as well. 

Essential Duties and Responsibilities:

• Complete initial, reassignment and revalidation applications with Medicare for entities and providers.
• Complete initial, reassignment and revalidation applications with various state Medicaid’s for entities and providers.
• Complete initial, reassignment and revalidation applications with various commercial insurance payers for entities and providers.
• Maintain PECOS portal for providers, including approval of facilities and updating demographic information.
• Manage and maintain NPPES portal for providers.
• Create, update, and maintain CAQH profiles for providers.
• Complete privileging for facility enrollment paperwork for providers and return to the facility in a timely manner.
• Support clients through providing advisory services for organizational level NPI management and provider enrollment challenges. 
• Manage Availity portal for various insurance networks.
• Communicate regularly with clients and associated providers to ensure timely completion of enrollment application process. 

Required Skills:

• Subject matter expertise in credentialing & payer enrollment. Extensive knowledge in health insurance third party administrator concepts specifically supporting operational processes for enrollment and eligibility functions. Revenue cycle workflow and operations experience a plus. 
• Working knowledge of PECOS, Medicaid, and CAQH systems. Knowledge of health insurance, HMO, PPO, DSNIP and managed care principles including Medicare Advantage regulations.
• Effective decision-making, problem-solving, conflict resolution, and critical thinking skills.
• Ability to learn new software programs quickly. Proficiency in Microsoft Office suite. Experience with Echo One App, Verity products, or other credentialing software solutions a plus.
• Provides exceptional customer service. This includes professional and effective interaction skills with co-workers, clients, providers, and vendors.
• Advanced verbal and written communication skills.
• Advanced project management, planning and prioritization skills.
• Ability to drive and support innovation and best practices.
• Readily adapts to changing work demands, is flexible and works independently and will take initiative making independent decisions.
• Serve others with integrity and maintain confidentiality. 

Required Experience and Education:

• 5-7 years’ experience working within the insurance agency, hospital or other healthcare setting with responsibilities related to credentialing or provider enrollment.
• Additional 1-3 years’ experience working within the healthcare industry relating specifically to the revenue cycle process.
• Associate or bachelor’s degree preferred. 

Job Type: Full-time

Schedule: Monday to Friday 

Work Location: Hybrid remote in Boise, ID 83713