Payer Enrollment Credentialing Specialist (Remote)

Radia Medical Imaging•Lynnwood, WA

7h•$25 - $36•Remote

About The Position

The Payer Enrollment Credentialing Specialist role manages and maintains the credentialing processes to ensure compliance with regulatory standards and organizational policies. The ideal candidate is service-oriented, communicative, and excels at managing time, priorities, and details in a fast-paced, remote work environment. This is a remote position.

Requirements

High school diploma, GED or suitable equivalent.
Experience with CAQH, PECOS and Medicaid required.
2+ years of experience in hospital medical staff setting in professional and/or payer credentialing and enrollment.
Knowledge of medical credentialing and privileging procedures and standards and Out of State Medical Board Licensure application process.
Excellent verbal and written communication skills.

Nice To Haves

Credentialing certification preferred; ongoing education encouraged.
Experience supporting teleradiology practices (e.g., Radiology Partners, Envision) preferred.

Responsibilities

Payor Enrollment: Manage and maintain enrollment for a large provider group across various payors, Medicare and Medicaid, maintain CAQH and PECOS provider profiles and serves as the primary contact for providers regarding enrollment status and documentation needs.
Credentialing: Completes accurate and detailed professional applications for hospitals and/or payers. Follows for review and signature in a timely manner, with a goal of having applications completed within 120-day maximum timeline. Ensures that approval for hospital and payer privileges and effective dates are documented in detail.
Interdepartmental Collaboration: Upholds a high level of understanding of credentialing and privileging and how it relates to other facets within (such as teleRadia, physician scheduling, quality and risk management) and outside of the organization. Recognizes opportunities for improving processes and can communicate effectively with physicians and hospital partners.
Primary Source Verification: Completes primary source verification as requested by management for new and existing physicians to ensure due diligence.
Proctoring: Coordinates and documents proctoring process per hospital requests and internal needs based on current approved policy and guidelines.
Continuing Medical Education: Works with team members to maintain current CME documentation for all medical professionals. Ensures that current information is provided to the clinical manager on a quarterly basis for MQSA accreditation and that totals yearly satisfy WA licensure requirements. Alerts physicians falling behind requirements.
Records Management: Maintains assigned physician files, updating each item/action as processed. Utilizes database status/alert and other report functions, software tools and links to scanned documentation. Ensures that information is current and accurate. Archives documents based on retention schedules.
Credentialing Standards: Credentialing standards as prescribed and actively participates in credentialing standards development contributing to standards and consistency in database entry to ensure accurate and consistent processes. Provides updates on outstanding items.
Medical Staff Application Fees & Dues: Processes check requests for Medical Staff App fees and dues based on invoices provided by various hospitals. Ensure that invoices are accurate prior to submitting payment.
Back-up Coverage: Provides support as assigned to other members of the Credentialing group.
Record Maintenance: Maintains files of scanned and/or hard copy documents for easy retrieval, ensuring that filing and other documentation are current. Archives documents based on retention schedules.