Provider Enrollment Specialist (Credentialing)

Job Description

Job Description

Seeking a full-time credentialing specialist to join our large pediatric multi-specialty practice. Flexible work hours available with the possibility of Hybrid schedule after 3 months.

SUMMARY: Coordinates all functions related to the credentialing and recredentialing of health care providers with both hospitals and payers and maintains provider credentialing files.

DUTIES AND RESPONSIBILITIES:

• Receives and processes all initial credentialing and recredentialing applications.
• Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
• Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
• Maintains accurate and complete records of each application’s status.
• Enters all provider information into database.
• Prepares all documents to be reviewed by hospital Credentialing Committees
• Maintains all credentialing and recredentialing timelines and schedules.
• Maintains strict level of confidentiality on all matters pertaining to provider.
• Maintains well-organized provider files that are easily reviewed by credentialing committee, outside review bodies, and others.
• Processes approval, denial, or termination letters.
• Performs other related duties as assigned by management.

QUALIFICATIONS:

• Bachelors degree, or associates degree with equivalent experience and training
• 2+ years experience in provider credentialing strongly preferred
• Commitment to excellence and high standards
• Excellent written and oral communication skills
• Ability to manage priorities and workflow
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm
• Ability to work independently and as a member of various teams and committees
• Proficient on Microsoft Word and Excel. Experience using credentialing software strongly preferred.
• Acute attention to detail
• Demonstrated ability to plan and organize projects
• Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
• Ability to communicate professionally and effectively in person, on the phone, electronically, or through other means to individuals and groups.

JOB TYPE / WORK SCHEDULE:

• This is a full-time position, in-office position - Hybrid after 3 months
• Standard office hours, Monday – Friday
• Bilingual Preferred

Competitive pay and a full benefits package, including 401(k), health, dental, vision, life, and disability insurance.