Credentialing Enrollment Specialist

Advocate Health and Hospitals Corporation•Charlotte, NC

1d•Onsite

About The Position

The Credentialing Enrollment Specialist performs primary source verifications for managed care credentialing and re-credentialing of MGD providers. This role provides issue resolution and support for billing issues related to provider enrollment and credentialing for MGD providers and the Central Billing Office. The specialist enters provider data into the ECHO database, follows established departmental processes, and communicates applicant status to other System entities. Responsibilities include ongoing follow-up for necessary information such as expired licenses, board certifications, insurance, and DEA registrations, ensuring timely receipt. The role also involves preparing physician files for audits by managed care organizations, Corporate Compliance, and accreditation entities, conducting practice site visits for MGD practices, and facilitating communication to ensure timely and accurate information flow to Managed Care Organizations (MCOs) and the System. Additionally, the specialist reviews provider directories and other information from managed care organizations to ensure accuracy of MGD and System demographics and participation, and provides support to the CPN Credentialing and Quality Review Committee.

Requirements

High school diploma or GED required.
Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is required.
Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone required.
Experience in typing, word processing, and business correspondence is required.
Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies.
Use of personal vehicle required.
Intact sense of sight and hearing required.

Nice To Haves

Bachelor's degree preferred.
Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.

Responsibilities

Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.
Conducts practice site visits for practices within MGD.
Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation.
Provides Team member support to the CPN Credentialing and Quality Review Committee.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program