Credentialing & Payor Enrollment Specialist

Role Description

The Credentialing & Enrollment Specialist supports credentialing and enrollment processes to ensure all strategic partner providers are enrolled with insurance payors timely and efficiently. This role has high impact on revenue cycle and positive provider and payor relationships.

• Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire.
• Maintains accurate provider records and makes edits to provider profiles. Enters new providers and updates data, as needed.
• Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates.
• Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities, staying apprised of provider candidates’ statuses and alignment of tasks/goals as an individual and a team.
• Supports strategic partners and internal counterparts to answer inquiries and provides enrollment and credentialing updates.
• Serves as subject-matter-expert for providers with onboarding instructions and support.
• Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results.
• Develops relationships to achieve quality goals, implement best practices and redesign systems and processes.
• Identifies gaps in client support/performance and proposes solutions (e.g. technology, services) to drive performance improvement.
• Works collaboratively with team members to address new issues as they arise and responds promptly with acknowledgement or status.
• Proficient use of various HIS and Enrollment Software.
• Enters provider applications into payer portals for enrollment.
• Demonstrates proficiency in the use of databases, CAQH, NPPES, Licensing Boards, and payer Web sites that will be used daily.
• Verifies data for accuracy and completeness.
• Responds to insurance payers’ requests for information in a prompt and professional manner.
• Works as a team with outside vendors and facilities who share the goal of enrolling our providers.
• Maintains confidentiality with providers’ personal information and upholds respect for privacy and regulatory requirements.
• Provides excellent customer service.
• Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility.
• Alerts leadership to any potential risk regarding meeting deadlines, set standards or goals in place.

Qualifications

• 1 to 3 Years of job experience.
• High School Diploma, GED, or Equivalent Experience.

Requirements

• Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS).
• Knowledge and understanding of State Medicaid Portals.
• Experience working with insurance enrollments, strongly preferred.
• Intermediate proficiency level in Excel.
• High level of attention to detail with the ability to solve problems and function independently.
• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
• Strong verbal and written communication skills.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Benefits

• Bonus Incentives.
• Paid Certifications.
• Tuition Reimbursement.
• Comprehensive Benefits.
• Career Advancement.
• This position pays between $19.75-$23.50 per hour based on experience.
• This role is remote, however, may require travel.