Enrollment & Credentialing Specialist

HEALTHSOURCE OF OHIO•Loveland, OH

7d•Hybrid

About The Position

This is a hybrid-remote position that requires 30-days in office training. After 30 days, may be eligible to work a hybrid-remote schedule which will include 2-3 in office days per week. Responsible for all aspects of the credentialing, re-credentialing, and provider enrollment processes for the providers of Centerprise’s clients. Responsible for ensuring providers are credentialed and enrolled with health plans. Maintain up to date data for each provider in credentialing databases and online systems. Responsible for maintaining Centerprise’s credentialing database. Communicates with Centerprise clients regarding credentialing and re-credentialing terms and changes. Assists operational and billing staff with health plan coverage issues. About the Company: Centerprise is a professional services organization providing consulting and Revenue Cycle Management services to Federally Qualified Health Centers (FQHCs). We are located outside Cincinnati, Ohio, and conduct business nationally. Centerprise is a company on the rise! We are very excited to say that we currently employ 25 staff members, and we are steadily growing! We take great pride in focusing on employee satisfaction. Happy employees; means happy customers! At Centerprise we offer our clients a wide variety of services, therefore, we require a large range of skill sets within our company. We would love to hear from dynamic individuals who are seeking an opportunity to grow their skills in an upbeat, fast paced, and team-based environment. Centerprise has a small company feel, with larger company resources. Please refer to our website for more information, www.ctprcm.com.

Requirements

To be eligible for remote portion, must have reliable Internet connection with a minimum download speed of at least 5Mbps, and upload speed at least 1 Mbps. Must have a dedicated work area with a door.
High School Diploma or Equivalent (GED), Associate Degree preferred.
Knowledge and understanding of the credentialing process. 2+ years of enrollment and credentialing experience required. FQHC experience is a plus.
Ability to organize and prioritize work and manage multiple priorities.
Excellent attention to detail.
Ability to research and analyze data.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets.
Familiarity and experience with CAQH and NCQA
Excellent written and oral communication skills

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) preferred.
FQHC experience is a plus.

Responsibilities

Facilitate provider credentialing and re-credentialing, obtaining required information as needed. Coordinates procurement of DEA, licensure, malpractice insurance information, and other required information to process applications.
Completes provider credentialing and re-credentialing applications; monitors applications and follows- up as needed. Ensures timely processing of all credentialing requests.
Maintains knowledge of current health plan and agency requirements for credentialing and enrolling providers.
Sets up and maintains provider information in online credentialing databases and systems, including CAQH and PECOS, to assure all credentialing information is accurate and up to date.
Maintain and update credentialing reports. Keeps an updated log of all pending and completed work.
Ensures practice addresses are current with health plans, agencies, and other entities.
Audits health plan directories for current and accurate provider information.
Communicates health plan coverage changes, additions, deletions across Centerprise and its clients.
Acts as liaison with health plans and assists operations and billing staff on issues.
Other duties as assigned

Benefits

Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts
401 (k) Program with competitive company match
Courtesy Plan, full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio office up to $500.00 per family
PTO and Long-Term Sick Bank, full time employees earn up to 25 days per year in first calendar year: 15 days of Paid Time Off (PTO), and 10 days of Long-Term Sick Bank (LTSB)
Credit Union Privileges, Sharefax Credit Union
Quarterly Bonus Incentive Program

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