Provider Enrollment/Credentialing Specialist

Omega Healthcare Management Services•Boca Raton, FL

About The Position

This role is responsible for managing and resolving credentialing, enrollment, and contracting tasks for providers. The specialist will provide essential data and reports to the Credentialing Team for provider enrollment with various insurance plans. Key duties include monitoring enrollment status, communicating with specialists, analyzing trends impacting charges, navigating payer portals for eligibility verification, and professionally handling claim denials for resolution and resubmission. The position also requires maintaining the confidentiality of patient and company information in accordance with HIPAA and other compliance standards, and performing other duties as directed in compliance with company policies.

Requirements

Minimum of 3-5 years prior experience in insurance follow up and/or credentialing and enrollment.
Associate’s degree or equivalent.
Proven experience in a customer service or call center role, preferably within the healthcare industry.
Ability to prioritize and multi-task in a fast-paced, changing environment.
Demonstrate ability to work in all work types and specialties.
Demonstrate ability to self-motivate, set goals, and meet deadlines.
Demonstrate problem-solving skills and the ability to think critically to identify and implement appropriate solutions.
Demonstrate excellent verbal communication skills, with the ability to effectively communicate contracting discrepancies to department leadership for review and resolution.
Strong active listening skills to understand patient concerns and provide appropriate resolutions.
Maintain courteous and professional working relationships with employees at all levels of the organization.
Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.
Ability to remain calm and composed in stressful situations, and effectively de-escalate any conflicts or disputes.
Compassionate and empathetic personality to handle patient inquiries and concerns with sensitivity and professionalism.
Skill in operating a personal computer and utilizing a variety of software applications is essential.

Nice To Haves

Additional education in healthcare business preferred.

Responsibilities

Effectively reviews and resolves credentialing/enrollment and contracting tasks.
Provides data for Credentialing Team in the form of reports and claims required for provider enrollment with various insurance plans.
Accurately monitor and communicate with Credentialing Specialists.
Analyzes trend impacting charges.
Effectively navigate payer portals to verify insurance eligibility and to identify the difference between payer plans.
Professionally communicate claim denials with insurance payers to determine accurate denial information for resolution.
Appropriately update denied claims and file for resubmission.
Monitors provider enrollment status and responds to credentialing and enrollment discrepancies.
Ensures and maintains the confidentiality of patient information and other company information in accordance with HIPAA and other compliance standards.
Performs other duties as directed.
Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.