Credentialing Specialist

Description

Join EmergeOrtho as a Credentialing Specialist and Work from Home!

EmergeOrtho is committed to being the trusted leader in innovative, quality-focused comprehensive musculoskeletal care. With offices across North Carolina, we're currently seeking a detail-oriented Credentialing Specialist to join our team. The Credentialing Specialist processes credentialing and re-credentialing applications for medical providers. Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Analyzes and prepares reports on trends in application status.


Why Join EmergeOrtho?

• Hiring Immediately - Start your new career without delay
• Flexible Schedule - Designed to fit your lifestyle and promote work-life balance
• Remote Work Environment - Work comfortably from home while staying connected to a dedicated and collaborative team

Who Should Apply?

If you're detail-oriented, thrive in fast-paced environments, and enjoy ensuring compliance and accuracy in professional records, we want to hear from you! Join a collaborative team where your expertise empowers healthcare operations every day - apply now and help shape the future of credentialing excellence!

Requirements

Qualifications and Experience

• High school diploma or equivalent
• Minimum three years' experience in the related field required, healthcare or medical practice setting preferred

Responsibilities include, but are not limited to, the following

• Maintain confidentiality of provider information
• Completion and coordination of paperwork for ERA, EDI, EFT, and other electronic means between organization and payer in athenaNet, and with Enrollment Services
• Ensure re-credentialing/revalidations are completed timely to prevent any lapse in enrollment
• Responsible for the accurate load and maintenance of Medical Group / Provider Enrollment page and associated tasks and timelines
• Communicate with hospitals, payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the effective credentialing or enrollment need
• Maintains knowledge of current health plan and agency requirements for credentialing providers
• Maintain CAQH, PECOS and NC Tracks.
• Ensure practice addresses are current with government health plans, agencies and other entities
• Maintain confidentiality of provider information
• Terminate enrollment with government payers upon resignation or termination of provider
• Update and maintain NPPES file for providers
• Along with any of the organization's proprietary spreadsheets or software purchased or leased, use athenaNet as the primary source of immediate notification and maintenance of enrollment related data in a timely manner
• Responsible for timely response of the Enrollment Services Dashboard tasks and overall maintenance and content
• Communicate with athenahealth Enrollment Services as needed both verbally or through tasks and cases Create clear and distinct notes in athenaNet to apprise any organizational or athenahealth employees of the most current status and actions, or pending needs
• Inclusion into Tier(s) and Custom Claims Worklists teams, use of AR reporting (by Report Builder or kickcodes) to identify blocks of revenue which are/were affected by enrollment-related issues and work singularly or with appropriate organization team and athenaheath resources toward resolution (using CSC / Case workflow)
• Measure and monitor the volume of AR pending for credentialing / enrollment reasons for providers and payers as a percent of overall AR for the provider or payer in question
• Performs other duties as required and assigned by the Manager, including schedule changes and travel to office locations as assigned

From the mountains to the coast, EmergeOrtho is North Carolina's premier provider, recognized for offering world-class, comprehensive, and compassionate care serving patients with 67 locations in 28 counties. As the largest physician-owned orthopedic practice in the state and the 2nd in the country, EmergeOrtho's medical team includes upwards of 190 highly trained orthopedic specialists and nearly as many advanced practice providers. Our subspecialty orthopedic teams offer advanced expertise in conditions of the bones, muscles, and joints. Providing multiple locations, extensive orthopedic services including therapy, and focusing on continuity of care are among the top priorities of EmergeOrtho. Please visit for additional information or to apply directly.


EmergeOrtho, P.A. complies with applicable civil rights laws and does not discriminate based on race, color, religion, national origin, age, sex, gender identity or expression, sexual orientation, pregnancy, childbirth and related conditions, including but not limited to, lactation, disability, veteran status, genetic information, or any other class protected by the state or local law.


We are committed to the core values of Quality, Innovation, Compassion, Community, Education, Integrity, Teamwork, Diversity, and Inclusion.


Benefits:

• 401(k) Retirement plan
• Health Insurance
• Dental Insurance
• Vision Insurance
• Flexible spending account
• Health savings account
• Paid time off
• Holiday Pay
• Employee Assistance Program
• Life Insurance
• Short Term Disability
• Long Term Disability
• Pet Insurance
• Milestone Bonus Program
• For more information:

Note: Available benefits based on hours worked per week.