Credentialing Enrollment Specialist - REMOTE

Advocate Health and Hospitals Corporation•Charlotte, NC

1d•Remote

About The Position

The Credentialing Enrollment Specialist performs primary source verifications and supports credentialing and re-credentialing for managed care providers. The role handles provider enrollment and credentialing billing issues, maintains provider data in the ECHO database, follows up on missing or expiring credentials, and prepares files for audits. It also includes conducting practice site visits, supporting timely communication with managed care organizations and system entities, reviewing provider directories, and providing team-member support to the CPN Credentialing and Quality Review Committee. The position is remote and is scheduled Monday through Friday, 8:00 AM to 4:30 PM, for 40 hours per week. It may involve occasional travel to other corporate offices, and use of a personal vehicle is required. The work is subject to time sensitivity, heavy volumes, and frequent interruptions.

Requirements

High school diploma or GED.
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.

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 verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
Resolve issues and provide 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 managed-care-organization materials reflecting MGD and System demographics and participation.
Provide team-member support to the CPN Credentialing and Quality Review Committee.

Benefits

Paid Time Off programs
Medical, dental, vision, life, and short- and long-term disability benefits
Flexible Spending Accounts for eligible health care and dependent care expenses
Adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Career development programs
Potential annual increases based on performance
Incentive pay for select positions
Premium pay such as shift and on-call pay, based on teammate eligibility