Credentialing and Provider Enrollment Specialist

Vytalize Health • Kansas City, KS

2d

About The Position

As a Credentialing and Provider Enrollment Specialist, your primary responsibility is to compile, maintain, and verify provider data and profiles. Operating in both delegated and non-delegated payors, you will efficiently complete provider enrollment and re-credentialing applications for various insurance plans, ensuring accuracy and adherence to deadlines. Communication is key as you interact professionally with providers and liaisons to gather required information. Your role involves monitoring and updating expiring licenses and certifications, tracking enrollment details, and conducting audits for plan directories. In this fast-paced environment, you maintain confidentiality, resolve enrollment issues, and contribute to the seamless functioning of the credentialing process.

Requirements

• 2 years of administrative background in a healthcare setting.
• 2 years of credentialing and re-credentialing experience.
• Knowledge of CAQH, AMA, DEA, CMS, PECOS, OIG, ABMS, AOA, OPSED.
• Strong organizational and data entry skills.
• Effective communication (verbal and written).
• Proficiency in Microsoft Office (Excel, Word, PowerPoint, and Outlook).
• Experience with Symplr and Intellicred software programs.
• Familiarity with commercial and government payors.
• Strong working knowledge of NCQA regulations and requirements.
• Ability to work independently and as a team player.
• Ability to create and present PowerPoint and Excel presentations.
• Manage tasks in a high-volume environment with competing deadlines.
• Maintain confidentiality while handling sensitive provider data.
• Resolve provider enrollment issues efficiently.
• Stay updated on industry regulations and compliance standards.

Responsibilities

• Compile, maintain, and verify provider data and profiles
• Accurately and efficiently complete provider enrollment and re-credentialing applications for all insurance plans
• Works in both delegated and non-delegated payors, credentialing, and rostering providers for participation
• Professionally communicate with all providers and provider liaisons while requesting and obtaining information
• Monitor and update all expiring licensure, boards, and professional certifications
• Track all provider enrollment and participation with effective dates, ID numbers and plan specification
• Research and resolve all provider enrollment issue
• Audit Commercial and Medicaid plan directories for current and accurate provider information
• Ability to work in a fast-paced, high-volume environment with multiple competing deadlines
• Maintains confidentiality of provider data
• Perform other related duties as assigned by management

Benefits

• Competitive base compensation
• Annual bonus potential
• Health benefits effective on start date
• Health & Wellness Program; up to $300 per quarter for your overall well-being available on start date
• 401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary
• Unlimited (or generous) paid "Vytal Time", and 5 paid sick days after your first 90 days
• Company paid STD/LTD
• Technology setup
• Ability to help build a market leader in value-based healthcare at a rapidly growing organization

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed