Credentialing and Enrollment Specialists

Marathon Health

21h • $24 - $32

About The Position

The Credentialing and Enrollment Specialist is responsible for coordinating all aspects of the credentialing and enrollment functions for Marathon Health including ensuring the timely and appropriate coordination, monitoring, and completion of the initial credentialing and re-credentialing verification processes and payer enrollment process for all Marathon Health practitioners.

Requirements

• Bachelor’s degree in business administration or a health care-related discipline and a minimum of 2+ years’ healthcare credentialing and/or enrollment experience, or equivalent combination of education and experience.
• CPCS or CPMSM certification preferred.
• Prior professional experience working with personal information and maintaining confidentiality.
• Knowledge of or familiarity with NCQA and AAAHC credentialing standards.
• Knowledge of or familiarity with laws and regulations affecting credentialing and enrollment.
• Experience working with electronic medical record software Athena strongly preferred.
• Prior credentialing and database experience preferred.
• Ability to effectively prioritize and execute tasks on time in a fast-changing environment, comfort with, and prior exposure to, ambiguity in a business environment.
• Solid interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at various levels across the company and to foster a positive work environment.
• Demonstrated time management skills and ability to handle multiple priorities and meet deadlines.
• Solid problem-solving skills with the ability to work and think outside the box.
• Demonstrated proactive behavior and a "can do" attitude; highly motivated, goal-oriented self-starter.
• Strong communications skills including the ability to listen effectively to customers to gain an understanding of client/patient needs and the ability to communicate information clearly and effectively.

Responsibilities

• Coordinate the initial credentialing and recredentialing processes for all healthcare providers.
• Collect, review, and verify provider credentials, including education, training, licensure, certifications, and work history.
• Ensure timely and accurate submission of credentialing documentation within the credentialing software.
• Efficiently use the organization’s credentialing software to track and manage credentialing activities.
• Maintain accurate and up-to-date provider records within the credentialing system.
• Verify provider credentials through primary source verification (PSV) in accordance with organizational policies and regulatory requirements.
• Ensure all provider credentials are current and compliant with state, federal, and organizational standards.
• Collaborate with internal departments, such as Talent Acquisition, Operations, Revenue Cycle Management, and Field Operations to ensure seamless onboarding, credentialing, and enrollment of providers.
• Serve as a point of contact for providers regarding credentialing and enrollment status and requirements.
• Assist in preparing credentialing files for review by the credentialing committee.
• Participate in quality assurance activities related to credentialing and enrollment processes to ensure continuous compliance and efficiency.
• Identify opportunities for process improvement within credentialing and enrollment functions and suggest enhancements to workflows or systems.
• Stay informed about changes in credentialing, enrollment, and payer regulations and standards, and update processes accordingly.
• Work with commercial payers to enroll providers with client insurance plans.
• Assist providers in completing enrollment applications for commercial payers.
• Act as a liaison between health plans and the organization to resolve enrollment inquiries and issues.
• Follow enrollment processes and procedures for commercial payers.
• Provide frequent status updates to Revenue Cycle Team and Operations leaders regarding enrollment progress through to completion.
• Maintain complete and accurate records of all credentialing and enrollment activities and documentation.
• Ensure that all documentation is stored securely and in compliance with organizational policies and regulations.
• Other projects, as assigned.

Benefits

• Comprehensive Health & Wellness Benefits: Choice of 2 medical plans, 2 dental plans, and vision coverage, unlimited free mental health benefits and EAP resources, Rewards for challenges and healthy lifestyle activities
• Family Friendly & Reproductive Health Benefits: Family-building and hormonal health benefits and paid parental leave
• Time-Based Benefits: Generous PTO or FTO, Paid Holidays + A Day for What Matters
• Financial Support: Company paid Basic Life and Disability insurance, Supplemental Life, Spending Accounts, 401(k) with employer match and graded vesting
• Continuing Medical Education (CME) for maintaining and strengthening the knowledge, skills, and expertise of our health center teammates, as applicable

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level