Credentialing & Provider Enrollment Specialist

Greater Philadelphia Health Action•Philadelphia, PA

7d•Hybrid

About The Position

Greater Philadelphia Health Action, Inc. (GPHA) is a cutting edge Joint Commission-Accredited healthcare organization and premier provider of primary medical, dental, and behavioral healthcare for more than 55 years. We are one of the largest ambulatory health centers in the region! Because of our success and stability, GPHA has become an employer of choice, offering our employees competitive salaries and a full array of benefits and rewards to include performance bonuses, medical, dental, and life insurance, tuition reimbursement, paid-time-off, holiday pay, 401(k) with LUCRATIVE company match, and a collaborative work environment. We are presently seeking a second Credentialing & Provider Enrollment Specialist at GPHA’s Executive Offices located at Carl Moore Health Center in Southwest Philadelphia. Hybrid work schedule is available, but this position must work at least 3 days in the office, so we ask that candidates reside within a commutable distance to Philadelphia. LOCAL CANDIDATES ONLY.

Requirements

At least two to four years of college education.
A minimum of two years’ credentialing experience in a Health Center environment (or Managed Care Organization (MCO)).
Detailed understanding of provider enrollment and payment processes.
Good computer and analytical skills.
Good interpersonal and communication (both written and verbal) skills required.
Must reside within a commutable distance to Philadelphia.
Local Candidates only.

Responsibilities

Responsible for credentialing, re-credentialing, provider enrollments and files maintenance for GPHA’s Licensed Independent Practitioners (LIP’s).
Ensure proper enrollment of all GPHA Dental (and potentially medical and behavioral health as may be required) providers into the various payer programs.
Facilitate dental provider enrollments into our plans via CAQH and manually for plans that require it.
Manage provider numbers for all GPHA providers and locations.
Perform all duties associated with the daily responsibilities of the various Managed Care programs to ensure all providers’ files are kept up to date.
Ensure providers are enrolled (credentialed) properly and re-credentialed properly in ALL plans with no delays or lapses as a participating provider.
Provide excellent customer service and use appropriate language in all communications.