Credentialing Enrollment Specialist

Advocate Health • Charlotte, NC

4d • $24 - $36 • Remote

About The Position

The Credentialing Enrollment Specialist oversees internal processes and procedures, along with governmental and regulatory requirements, to support timely and accurate completion and submission of provider applications. The role also assists with departmental planning, development, and organization.

This position supports managed care credentialing and re-credentialing for MGD providers, including verification of source documentation, provider data entry, follow-up on outstanding credentials, file preparation for audits, and communication with managed care organizations and System entities. It also provides support related to provider enrollment and credentialing billing issues and participates in practice site visits and committee activities.

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 with typing, word processing, and business correspondence.
• Ability to perform duties involving frequent English verbal and written communication with employees, corporate staff, providers, and external agencies.
• Ability to travel occasionally to other corporate offices; use of a personal vehicle is required.
• Ability to perform the stated physical duties, including sitting for extended periods, standing, walking, repetitive wrist and arm motions, and lifting articles weighing 20–50 pounds.

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 regarding 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 to verify MGD and System demographics and participation.
• Provide team member support to the CPN Credentialing and Quality Review Committee.
• Assist in departmental planning, development, and organization.

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.
• Premium pay, including shift and on-call pay, for eligible positions.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.

What This Job Offers

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