Provider Payer Enrollment Credentialing Administrator
Provider Payer Enrollment Credentialing Administrator
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
This is a hybrid role in office on Tuesday-Thursday and working from home on Monday and Friday.
Community Medical Services (CMS) is hiring a Credentialing Administrator. Under the supervision of the Credentialing Admin Supervisor the Credentialing Administrator is responsible for maintaining credentialing records files and reports for all staffed physicians nurses licensed counselors and all CMS facilities. This role will also prepare and submit required credentialing applications and primary source documents to state federal and statement Health Maintenance Organizations for initial and reappointment credentialing and payer enrollment or providers and facilities. This candidate will work collaboratively with several cross-functional teams in our fast-paced dead-driven environment.
As part of our mission to help individuals recover from substance use disorders youll thrive in a supportive engaging and fulfilling work environment where your contributions are valued.
Along the way well invest in your well-being through a benefits package for full-time employees that includes:
- Subsidized medical dental and vision insurance
- Health savings account
- Short and long-term disability insurance
- Life insurance
- Paid sick vacation and holiday time
- 401K retirement plan with match
- Tuition and CME reimbursement up to 100%
- Employee assistance program to support your mental health and wellness
- Ongoing professional development
Responsibilities:
- Compiles and processes provider documents to submit applications for payer and facility enrollment in compliance with federal state managed care and regional requirements.
- Maintains provider data to monitor applicant progress in the credentialing/enrollment/recredentialing process with Federal State and Managed Care organizations.
- Ensures consistent documentation and complete verification of provider credentials.
- Coordinates data collection from cross functional teams to be included in the credentialing files. Monitors the recruitment status of provider staff candidates to ensure timely credentialing submissions to State Medicaid Agencies Medicare and HMOs.
- Maintains credential and peer review files e.g. keeps all licensure certifications etc. current.
- Loads all applicable rendering providers into CMS Electronic Medical Record System and Electronic Health Record System.
- Has utilized the following data bases to manage the providers enrollments Pecos I&A NPPES APEP CAQH and Availity
- Able to navigate each of the health plans websites to submit payor enrollments or provider and facility (i.e Medicare State Medicaid/AHCCCS UHC/Optum BCBS Cigna Humana and Aetna )
- Medicare and Medicare revalidations according to each state level
- Identifies issues that require additional investigation and evaluation; validates discrepancies and ensures appropriate follow ups
- Interface with state and federal agencies such as Medicare Commercial and Medicaid Health plans providers facility licensing agencies on a regular basis.
- Use critical thinking skills to conduct follow-up with individual practitioners internal and external entities to resolve discrepancies identified during the credentialing process
Qualifications:
Education Certification and Experience Requirements:
- Requires an education level of at least a high school diploma or GED. Associates or Bachelor degree preferred.
- At least 3 years healthcare credentialing and enrollment experience is required.
- Basic familiarity with healthcare / medical industry is required.
- Computer skills to include PDF Microsoft Word Excel and basic data entry including the ability to learn new and complex
- computer system applications.
- Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
- Must be able to prioritize plan and handle multiple tasks/demands simultaneously.
Tools and Equipment Requirements:
- The ability to use a phone computer printer and copier is required.
- Frequent use of Microsoft office products including but not limited to Outlook Word Excel and PowerPoint.
- The ability to use the internet and various web browser software is required.
Physical Working Conditions and Office Setting Description:
- Requires sitting and standing associated with a normal office environment.
- Manual dexterity using a calculator and computer keyboard.
- Requires prolonged sitting standing frequent bending stooping or stretching.
- Some lifting may be required.
- Frequent and prolonged typing and frequent and prolonged operation of computer keyboard and telephones required.
- Requires occasional use of fax machines telephones copiers and other office equipment.
- Employee must regularly lift and/or move up to 10 pounds frequently lift and/or move up to 25 pounds and occasionally lift and or move up to 50 pounds.
#CRPSF
About Community Medical Services
Community Medical Services (CMS) is a CARF-accredited addiction treatment program providing services in the form of outpatient medication-assisted treatment and one-on-one and group counseling to those seeking help with their opioid use disorder. Headquartered in Arizona with more than 70 treatment clinics in eleven states CMS is dedicated to meeting the challenges presented by the growing opioid epidemic in communities where treatment is lacking.
Our Commitment
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion national origin sex disability status sexual orientation gender identity age protected veteran status or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Other Conditions
Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
