CREDENTIALING AND PAYOR ENROLLMENT SPECIALIST
About The Position
The Credentialing and Payor Enrollment Specialist is responsible for the timely and accurate submission of all initial hospital credentialing and payor plan enrollment for incoming providers, as well as recredentialing and reenrollment for existing providers. This role involves establishing and maintaining a database of provider information, serving as a liaison between providers and the CMO/insurance offices, and ensuring quality assurance in the processing of credentialing applications. The specialist will also maintain confidential provider files, manage CAQH/ADA attestations, process resignations and status changes, and attain qualification as a Notary Public.
Requirements
- High School diploma/ GED Required
- 1-3 years Hospital credentialing Required
- 1-3 years Insurance plan (Commercial, Medicaid, Medicare, and Medicaid/ Medicare Managed Care) enrollment Required
- Ability to work effectively with co-workers as a team member
- Ability to multitask in a fast paced environment
- Ability to work independently with minimal supervision
- Strong Interpersonal, oral, and written communication skills with excellent self-discipline and patience between payors, providers, physicians, and colleagues
- Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners discovers and conveys problems to Credentialing Manager
- Proficient computer software and database skills
Nice To Haves
- 1-3 years dental credentialing and insurance plan enrollment Preferred
Responsibilities
- Responsible for timely and accurate submission all initial hospital credentialing and payor plan enrollment for incoming providers
- Responsible for timely and accurate submission all hospital recredentialing and insurance plan reenrollment for existing providers
- Establish and maintain a database of all dental providers with complete credentialing and IPA information
- Serve as liaison between the providers and CMO and insurance offices. Proactively address any issues including missing documentation with providers
- Work closely with CMO and Dental Staff personnel to provide first line quality assurance in the processing of dental staff credential and re-credential applications in accordance with their regulations and requirements
- Attend and participate in CMO provider relations meetings
- Keep management informed early in the process of any delinquent or uncooperative providers
- Maintain confidential providers files in accordance with The Joint Commission requirements. Ensure documents with expiration dates are up-to-date, and follow-up with providers around renewals(i.e. license registration, DEA, board certifications etc)
- Maintain and update CAQH/ ADA Attestations for all eligible providers
- Manage and maintain taxonomy codes for all providers
- Process resignations and change of status with the CMO for all providers
- Attain qualification as a Notary Public
Benefits
- An assortment of insurance products and discount programs through Voluntary Benefits
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
