Credentialing and Provider Enrollment Specialist

Sea Mar Community Health Centers•Federal Way, WA

4d•$25•Onsite

About The Position

The Credentialing and Provider Enrollment Specialist is responsible for coordinating all aspects of the credentialing and privileging process for licensed independent practitioners (LIPs) in accordance with Sea Mar’s policies and procedures, national standards and regulatory requirements. This role is responsible for ensuring accurate and timely processing of site and provider enrollments for all Medicare, Medicaid, third party insurances, and private pay programs, including special programs, and is responsible for monitoring licensure and certification expirations. The Credentialing and Provider Enrollment Specialist is a solution-driven, detail-oriented professional who provides exceptional customer service to internal colleagues and external partners.

Requirements

Working knowledge of The Joint Commission, NCQA, URAC, CMS and HRSA credentialing and privileging standards.
Intermediate computer skills including Microsoft products, especially Microsoft Excel and web-based inquiries/databases required.
Demonstrated ability to manage and meet multiple priorities and competing deadlines.
Demonstrated problem-solving and organizational skills with attention to detail.
Ability to read and interpret complex documents, reports and data.
Ability to effectively and professionally communicate with providers, outside organizations and staff both verbally and in writing.
Ability to add, subtract, multiply and divide in all units of measure including whole numbers, common fractions and decimals required.
Ability to compile, interpret and utilize information.
Ability to work well with a diverse group of individuals including staff and clients.
Ability to resolve issues in a timely manner.
Ability to communicate detailed information and processes in a clear, concise manner, both verbally and in writing.
Must be detail-oriented with demonstrated ability to follow processes and instructions in order to complete enrollment applications and insurance plan provider credentialing requirements.

Nice To Haves

College degree preferred, high school diploma acceptable if previous work experience in managed care, hospital or medical office environment.
Experience in credentialing and/or provider enrollment preferred.
Experience with credentialing software is desirable, MD Staff preferred.
Experience with provider enrollment and delegated health plan credentialing agreements preferred.
Current NAMSS Certified Provider Credentialing Specialist (CPCS) or actively pursuing certification and certification obtained within two years of hire date preferred.

Responsibilities

Create and carry out various credentialing processes in relation to licensed providers in medical, dental and behavioral health departments.
Ensure that all credentialed providers adhere to facility and staff policies, department guidelines, regulations, and government laws.
Process applications and reappointment paperwork, checking for full completeness and accuracy.
Perform provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to Board of Directors.
Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per HPP and/or client facility policy and procedures.
Coordinate credentialing process by entering/logging/scanning information into MD Staff credentialing software for initial, updating, and add on applications and maintenance processes.
Collect and verify sensitive provider data through confidential sources.
Maintain timely updates to information systems and regular reports used to monitor completion of initial and reappointment credentialing applications.
Audit files based on internal standards and regulatory requirements.
Monitor and report application status and provide appropriate correspondence (form letters) to providers and department heads when necessary.
Provide complete and accurate credentialing files to Administration for inclusion in Board of Directors' materials.
Serve as back-up to the Credentialing and Enrollment Manager to coordinate and facilitate monthly Clinical Credentialing Committee meetings.
Inform the Credentialing and Enrollment Manager of any concerns or issues preventing timely credentialing and privileging of providers.
Maintain paper provider credentialing files in locked filing cabinets.
Maintain professional working relationships with facilities in which providers practice.
Work directly with providers to complete all phases of credentialing process.
Other duties as assigned