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
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