Provider Enrollment/Credentialing Specialist

V2V MANAGEMENT SOLUTIONS INC•Boise, ID

5d•$30 - $40•Hybrid

About The Position

Seeking an experienced Provider Enrollment/Credentialing Specialist to support a busy and dynamic healthcare consulting firm. Our firm specializes in working with medical practices across the United States. We are looking for an experienced individual to join our busy Provider Enrollment team. The ideal candidate not only understands provider enrollment and credentialing but has experienced the full revenue cycle function as well. The candidate must be a highly-motivated professional with great communication skills, ability to multi task, and excellent client relations experience. We are seeking an individual who is extremely detail oriented, can hit the ground running and make a difference! In joining our firm, you will be in an invigorating and challenging environment with high standards for work quality, professionalism, and teamwork. The opportunity exists for this position to participate in various aspects of client engagements depending on the experience the candidate brings to the position. The position can be both office based and/or a remote telecommuting position. The Provider Enrollment Credentialing Specialist will support clients through administering the provider enrollment and credentialing applications process. The Consultant is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. The Consultant will also support clients through providing advisory services for organizational level NPI management and provider enrollment challenges. This position supports client organizations with ensuring the provider onboarding process relating to credentialing and enrollment is a seamless and expedited experience thus improving the providers experience in joining an organization. Additionally, for established clients the Consultant will aid the client providers in re-credentialing efforts.

Requirements

Subject matter expertise in revenue cycle, credentialing & payer enrollment.
Extensive knowledge in health insurance third party administrator concepts specifically supporting operational processes for enrollment and eligibility functions.
Working knowledge of PECOS, Medicaid, and CAQH systems.
Knowledge of health insurance, HMO, PPO, DSNIP and managed care principles including Medicare Advantage regulations.
Effective decision-making, problem-solving, conflict resolution, and critical thinking skills.
Ability to learn new software programs quickly.
Proficiency in Microsoft Office suite.
Provides exceptional customer service.
Professional and effective interaction skills with co-workers, clients, providers, and vendors.
Advanced verbal and written communication skills.
Advanced project management, planning and prioritization skills.
Ability to drive and support innovation and best practices.
Readily adapts to changing work demands, is flexible and works independently and will take initiative making independent decisions.
Serve others with integrity and maintain confidentiality.
3-5 years’ experience working within the insurance agency, hospital or other healthcare setting with responsibilities related to credentialing or provider enrollment.
Additional 3-5 years’ experience working within the healthcare industry relating specifically to the revenue cycle process.

Nice To Haves

Experience with Echo One App, Verity products, or other credentialing software solutions.

Responsibilities

Administering the provider enrollment and credentialing applications process.
Preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers.
Providing advisory services for organizational level NPI management and provider enrollment challenges.
Ensuring the provider onboarding process relating to credentialing and enrollment is a seamless and expedited experience.
Aiding client providers in re-credentialing efforts for established clients.