Insurance Enrollment and Credentialing Coordinator - Per Diem - Day - Credentialing Lawrenceville NJ

Credentialing And Enrollment Specialist

Manages end-to-end credentialing and enrollment process, acting as a strategic liaison between providers, insurance entities and revenue cycle. Requires advanced analytical skills to evaluate complex documentation, ensure data integrity across many systems, and optimize the provider onboarding experience to safeguard group reimbursement.

MINIMUM REQUIREMENTS

• Education: High school diploma or equivalency.
• Experience: One year' provider credentialing and/or enrollment experience in a medical office environment. In lieu of required experience, three years' Revenue Cycle experience in a healthcare setting specifically in contracting, billing, registration, or administration in a physician office or hospital.
• Other Credentials: Knowledge and Skills: Ability to communicate effectively and possess strong customer service skills. Excellent organizational skills, attention to detail and accuracy required. Ability to handle large volume of work, prioritize tasks and work efficiently under pressure. Special Training: Proficiency in Windows based processing, excel spreadsheets & Credentialing software program. Knowledge or payer requirements relating to insurance credentialing and enrollment processing.
• Mental, Behavioral and Emotional Abilities: Usual Work Day: 8 Hours Reporting RelationshipsDoes this position formally supervise employees? No

ESSENTIAL FUNCTIONS

• Maintains expert-level understanding of evolving accreditation and insurance regulations, performing regular audits of provider files to mitigate risk and prevent credentialing lapses.
• Critically reviews and analyzes provider credentials, licenses, and certifications to ensure absolute compliance with state, federal, and payer-specific regulations.
• Continuous training and research of processes and systems across 24 different payer platforms to ensure accuracy and efficiency in regard to regulations, policies, guidelines and procedures.
• Updates health plans, agencies and other entities and systems to assure regulatory compliance with Federal and State mandates for current and accurate provider information.
• Facilitates end-to-end enrollment lifecycle, strategically attaching providers to group billing entities to ensure uninterrupted reimbursement and optimized cash flow.
• Analysis and completion of reports and data spreadsheets received from Payers. and other related applications to ensure timely revenue stream.
• Identifying and resolving problems related to claim submission and denials, often working with Revenue Cycle Operations.
• Manages complex project timelines for provider onboarding, utilizing advanced spreadsheet modeling and credentialing software to track milestones and resolve systemic deficiencies.
• Completes timely follow-up of any CH provider enrollment issues by utilizing software system reporting. Maintains departmental logs and spreadsheets for updating all insurance credentialing and re-credentialing.
• Acts as primary liaison between clinical providers, administrative leadership, and insurance representatives to expedite enrollment and resolve high-level billing discrepancies.
• Clear and effective communication with insurance companies handling complex questions and issues dealing with day-to-day operations of credentialing and payer enrollment that can affect revenue.
• Orchestrates accurate entry and maintenance of provider data across multiple systems and health plans to ensure organizational data integrity.
• Assures insurance provider numbers are entered into billing system for claims submission as well as communication with CHMG administrators and managers.
• Ability to manage multiple applications, track deadlines, and maintain organized records.
• Performs other related duties as required or assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include: Sitting, Standing, Walking, Keyboard use/repetitive motion

Occasional physical demands include: Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl, Wrist position deviation, Pinching/fine motor activities

Continuous physical demands include: Talk or Hear

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal HearingAnticipated Occupational Exposure Risks Include the following: N/A

This position is eligible for the following benefits:

• Retirement Savings and Investment Plan
• Disability Benefits Short Term Disability (STD)
• Sick Time Off
• Employee Assistance Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.