Credentialing Enrollment Specialist
About The Position
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.
Requirements
- High school diploma or GED required; Bachelor's degree preferred.
- 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.
- Use of personal vehicle required.
- Intact sense of sight and hearing required.
Nice To Haves
- 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
- Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
- Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- Benefits and more 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
11-50 employees
