Credentialing Enrollment Specialist

American Addiction Centers • Charlotte, NC

2d • $24 - $36 • Remote

About The Position

This position oversees the internal processes and procedures, as well as governmental and regulatory requirements, for the timely and accurate completion and submission of provider applications. It assists in departmental planning, development, and organization. The role performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers. It provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office. The specialist enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities regarding the status of applicants. They perform 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. The role prepares physician files for file audits by managed care organizations, Corporate Compliance, and accreditation entities. It conducts practice site visits for practices within MGD and facilitates communication tools and/or activities to maintain a timely and accurate flow of information to Managed Care Organizations (MCOs) and the System. The specialist reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation. They provide team member support to the CPN Credentialing and Quality Review Committee.

Requirements

• High school diploma or GED
• 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
• Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone
• Experience in typing, word processing, and business correspondence

Nice To Haves

• Bachelor's degree
• 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

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED