Credentialing & Payor Enrollment Specialist

Ensemble Health Partners•Work at Home - Ohio - Other, OH

1d•$20 - $24•Remote

About The Position

The Credentialing & Enrollment Specialist supports credentialing and enrollment processes to ensure all strategic partner providers are enrolled with insurance payors timely and efficiently. This role has high impact on revenue cycle and positive provider and payor relationships.

Requirements

1 to 3 Years of Job Experience
Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS)
Knowledge and understanding of State Medicaid Portals
Intermediate proficiency level in Excel
High level of attention to detail with the ability to solve problems and function independently
Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
Strong verbal and written communication skills
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Nice To Haves

Experience working with insurance enrollments, strongly preferred.

Responsibilities

Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire.
Maintains accurate provider records and makes edits to provider profiles.
Enters new providers and updates data, as needed.
Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates.
Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities, staying apprised of provider candidates’ statuses and alignment of tasks/goals as an individual and a team
Supports strategic partners and internal counterparts to answer inquiries and provides enrollment and credentialing updates.
Serves as subject-matter-expert for providers with onboarding instructions and support.
Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results.
Develops relationships to achieve quality goals, implement best practices and redesign systems and processes
Identifies gaps in client support/performance and proposes solutions (e.g. technology, services) to drive performance improvement.
Works collaboratively with team members to address new issues as they arise and responds promptly with acknowledgement or status
Proficient use of various HIS and Enrollment Software.
Enters provider applications into payer portals for enrollment.
Demonstrates proficiency in the use of databases, CAQH, NPPES, Licensing Boards, and payer Web sites that will be used daily.
Verifies data for accuracy and completeness
Responds to insurance payers’ requests for information in a prompt and professional manner
Works as a team with outside vendors and facilities who share the goal of enrolling our providers
Maintains confidentiality with providers’ personal information and upholds respect for privacy and regulatory requirements.
Provides excellent customer service.
Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility and alerts leadership to any potential risk regarding meeting deadlines, set standards or goals in place.