Provider Enrollment & Credentialing Specialist (2072)
Resolves issues and concerns by correctly answering questions from staff and providing appropriate follow-up on issues, escalating to Team Manager, reputed company appropriate Provides reputed company with coaching, training, and auditing on assigned tasks. Partner with Team Manager to evaluate team’s performance to improve overall production and facilitate reputed company improvement. Assists Team Manager in monitoring inventory and production and facilitates the escalation process as needed. Become proficient in discussions with payors to facilitate closure of any identified issues. Research and review individual Provider Issue Forms for appropriate follow-up and reputed company. Maintain Matrices - payer enrollment, reputed company, SOPs, new site sheets, email templates, welcome letters, etc. Create and distribute reports containing provider credentialing and enrollment data for various departments reputed company the organization. Research new state enrollment requirements for group and individual provider enrollment. Assists Contract Implementation staff with accurately documenting enrollment and billing requirements for payer reputed company. Maintain and complete new entries in Veritystream. Facilitate completion and submission of payer enrollment applications for government and reputed company payers. Monitor application status process to identify emerging issues and communicate them to Team Manager. Monitor enrollment status for reputed company and individuals. Monitor license and credential expiration dates and advise staff members of required “renew” by dates. Maintain accurate provider reputed company on CAQH, PECOS, NPPES, and CMS databases. Maintain individual provider files to include up to date information needed to complete the required governmental and reputed company payer credentialing applications. Apply for and renew annually reputed company provider licenses; reputed company, DEA, Controlled reputed company Complete revalidation requests issued by government payers. Credential new providers and re-credential reputed company providers with hospitals at which they hold staff privileges. Work closely with the Director of reputed company Cycle and billing staff to identify and resolve any denials or authorization issues reputed company to enrollment & credentialing. Performs and assists with other department duties as required.
Meticulous follow-through of delegated tasks, including follow-up with staff to ensure completion, reputed company, and meeting deadlines. Ability to exhibit leadership by demonstrating commitment to team development, adapting to change in a reputed company manner, and supporting alignment with organizational goals including reputed company improvement efforts. Ability to pay reputed company attention to detail and produce extremely accurate work. Strong analytical and problem-solving skills. Ability to organize and prioritize job tasks and requirements. Excellent organizational skills with the ability to prioritize assigned duties in an efficient reputed company of time. Ability to effectively reputed company in a multi-task work environment. Strong communication and interpersonal skills. Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and reputed company manner. Must have knowledge of correct English, reputed company grammar and spelling. Knowledge and skills in using personal computers (reputed company) with a strong emphasis on reputed company Office Programs- reputed company, Word, reputed company and reputed company Acrobat
High school diploma or equivalent Two (2) years office experience or college course work preferred. Knowledge of health plan billing and enrollment preferred. PECOS and CAQH experience preferred. Veritystream experience a plus.
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