Credentialing and Enrollment Specialist

Benevis•Atlanta, GA

About The Position

The Credentialing and Enrollment Specialist reports to the Manager of Credentialing and Enrollment and will be a key member of the Revenue Support Team. This role is primarily focused on ensuring timely, accurate and efficient credentialing and re-credentialing of all Benevis and Affiliated Entities, providers, and offices with contracted Medicaid and commercial insurance payors. The ideal candidate must be a self-starter in addition to being comfortable collaborating across various departments within the organization.

Requirements

A minimum of 4 years related healthcare experience with provider enrollment preferred in a high-volume environment in dental, medical, optometry, or medical staffing industries.
Ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem-solving skills, and attention to detail; and transcribe accurately
Proficient in using the Microsoft Office software applications (Excel, Word, PowerPoint)
Communicate effectively, both written and orally with dentists, payers, and interdepartmentally
Excellent organizational/time management and project management skills and multi-tasking abilities

Responsibilities

Processes credentialing and re-credentialing Medicaid and Commercial applications of dentists and track all progression steps in internal database.
Meets or exceeds individual productivity metrics, quality and timeliness standards as defined by department guidelines.
Review provider enrollment packets for missing information; requests missing information from provider; resolves discrepancies between information supplied and findings of other sources (NPDB, State Dental Boards, etc.)
Ability to accurately build provider records and to enter relevant information into the credentialing database and other ancillary data repositories as needed.
Ensure the provider’s credentials comply with requirements of contracted payers and well as preparing providers files for the credentialing committee according to NCQA regulations.
Maintains up-to-date physician database, including but not limited to medical licenses, drug enforcement administration certificates, professional liability insurance, provider numbers and renewal period expiration dates.
Research detailed information on provider status in response to telephone or written inquiries.
Researches and analyzes problems with enrollment packets and recommends resolutions.
Runs queries, generates reports and credentialing document verification requests.
Review correspondence received and perform appropriate action to resolve.
Troubleshoots provider related claims issues and work to resolve for Hold Provider claims for adjudication for in- network payments.
Other duties and special projects as assigned