Credentialing Enrollment Specialist - REMOTE

Advocate Health•Charlotte, NC

1d•$24 - $36•Remote

About The Position

The Credentialing Enrollment Specialist performs primary source verifications for managed care credentialing and re-credentialing of MGD providers. The specialist supports provider enrollment and credentialing issues related to billing, enters provider data into the ECHO database, and communicates applicant status to other System entities. The role follows up on expiring or missing credentials and prepares physician files for audits by managed care organizations, Corporate Compliance, and accreditation entities. The specialist also conducts practice site visits, supports timely and accurate information flow between Managed Care Organizations and the System, reviews provider directories and related demographic and participation information, and provides team member support to the CPN Credentialing and Quality Review Committee. Work is remote, with occasional travel to other corporate offices and use of a personal vehicle required. The schedule is Monday through Friday, 8:00 AM to 4:30 PM, for 40 hours per week.

Requirements

High school diploma or GED.
At least three years of experience in a role performing or supporting provider credentialing, privileging, and/or enrollment in a hospital, managed care plan, or CMS environment.
Knowledge of and experience with personal computers, Windows, Microsoft applications, copier and fax machines, and multi-line telephones.
Experience in typing, word processing, and business correspondence.
Frequent verbal and written communication in English is required.
Use of a personal vehicle is required.
Must have an intact sense of sight and hearing.
Ability to perform duties involving prolonged sitting, standing, walking, repetitive wrist or arm motion, and lifting articles weighing 20–50 pounds.
Ability to manage time-sensitive work, heavy volumes, and frequent interruptions.

Nice To Haves

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

Responsibilities

Perform primary source verification of documentation required for managed care credentialing and re-credentialing of MGD providers.
Provide issue resolution and support for billing issues related to provider enrollment and credentialing for MGD providers and the Central Billing Office.
Enter provider data in the ECHO database according to departmental processes and provide other System entities with applicant status updates.
Follow up on needed information, including expired licenses, board certifications, insurance, and DEA registrations, and ensure timely receipt.
Prepare physician files for audits by managed care organizations, Corporate Compliance, and accreditation entities.
Conduct practice site visits for practices within MGD.
Facilitate communication tools or activities to maintain timely and accurate information flow to Managed Care Organizations and the System.
Review hard-copy and electronic provider directories and other information produced by managed care organizations that reflects MGD and System demographics and participation.
Provide team member support to the CPN Credentialing and Quality Review Committee.