Credentialing Enrollment Specialist
Credentialing Enrollment Specialist
Posted on :
07-04-2025
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1 Vacancy
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Job Description
Description
Perform most duties under normal office conditions which may include sitting for long periods of time standing walking using repetitive wrist/arm motion or lifting articles 2050 pounds. Work is subject to time sensitivity heavy volumes and frequent interruptions either by phone or other employees. Must use frequent and variable body movements during filing and maintaining records. Require frequent verbal and written communication in English to employees corporate staff providers and external agencies. Require occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.
Job Summary
Oversees the internal processes and procedures as well as Governmental and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning development and organization.
Essential Functions
- Performs primary source verifications of documentation required for managed care credentialing and recredentialing of MGD providers.
- Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
- Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
- Performs followup on needed information (expired licenses board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
- Prepares physician files for file audits by managed care organizations Corporate Compliance and accreditation entities.
- Conducts practice site visits for practices within MGD. Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
- Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the Systems demographics and participation.
- Provides Team member support to the CPN Credentialing and Quality Review Committee.
Perform most duties under normal office conditions which may include sitting for long periods of time standing walking using repetitive wrist/arm motion or lifting articles 2050 pounds. Work is subject to time sensitivity heavy volumes and frequent interruptions either by phone or other employees. Must use frequent and variable body movements during filing and maintaining records. Require frequent verbal and written communication in English to employees corporate staff providers and external agencies. Require occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.
Education Experience and Certifications
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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