Thursday, September 26, 2024

The Credentialing & Enrollment Specialist is responsible for coordinating, monitoring and maintaining the credentialing/provider enrollment and re-enrollment process in a timely and compliant manner, in accordance with departmental procedures, with all contracted commercial and government payors. The specialist will maintain communication with Internal/External customers, ensuring accuracy of provider applications and creating efficiency for the on-boarding process.

Obtains all provider information and documentation necessary for all health plans, including Medicare, Medicaid and Managed Medicaid
Manage and follow up on submission and processing of applications within the appropriate timeframe with all health plans/ payors.
Ensure providers obtain and maintain medical malpractice insurance.
Ensure all internal and external databases are updated and current.
Ensure primary source verifications occur for internal processing, as well as external customers (i.e. State Boards)
Assist and prepare for audits.
Process all status changes and terminations with respect to payors.
Communicate expiring documents to providers and assist as necessary to ensure that updated documentation is collected.
Maintain necessary reporting and documentation for expiration monitoring and re-enrollment processes for locations and providers.
Communicate directly with internal and external customers to ensure all requirements are completed accurately and timely, providing excellent customer service to all internal and external parties.
Communicate with and manage enrollment vendor(s).
Assist with the location enrollment process, including gathering and documenting requirements and ensuring completion of new site additions in a timely manner.
Run reports and distribute to appropriate individuals regarding approved providers and licensed professionals and projected start dates.

Skills & Abilities:

Extensive knowledge of Microsoft Suite and other programs specific to the company
Excellent communication skills, both verbal and written.
Strong organizational and time management skills.
High level of accuracy and attention to detail.
Ability to multitask and prioritize.
Must regularly exhibit all Hulin Health Core Values and intuitively identify these values in candidates throughout the recruiting process.
Must exhibit professionalism and high ethical standards at all times.
Ability to identify and resolve problems in a timely manner, by gathering and analyzing information and developing alternative solutions.

Education and Experience:

Bachelors’ degree preferred; Will consider candidates with experience in medical staff services or certified Professional Medical Staff Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) in lieu of degree.
Two years of healthcare experience preferred, such as EDI transaction, credentialing, and Medicare/Medicaid Enrollment or Managed Care Enrollment.

Community Care Partners is an Equal Opportunity (EEO) Employer #J-18808-Ljbffr

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Credentialing & Enrollment Specialist