Payer Enrollment Specialist

We are seeking a highly organized and detail-oriented FQHC Insurance Credentialing Specialist to oversee the credentialing and re-credentialing processes for a team of 20+ medical, mental health, and dental providers. This role is responsible for ensuring that all providers meet compliance requirements with federal, state, and commercial insurance regulations, as well as accrediting and licensing bodies. The ideal candidate will have extensive experience in credentialing within a Healthcare or preferably Federally Qualified Health Center (FQHC) setting and the ability to manage the entire credentialing life cycle efficiently.

ESSENTIAL FUNCTIONS:

• Manage and oversee the insurance credentialing and re-credentialing process for all providers, including medical, mental health, and dental professionals.
• Maintain up-to-date and accurate insurance credentialing files in accordance with organizational policies and regulatory requirements.
• Ensure timely submission and follow-up on insurance credentialing and payer enrollment applications with Medicare, Medicaid, and commercial insurance providers.
• Monitor provider licenses, DEA registrations, and certifications to ensure compliance with expiration dates and renewal requirements.
• Collaborate with internal departments, including Human Resources, Billing, and Compliance, to streamline provider onboarding and credentialing processes.
• Develop and implement policies and procedures to enhance the efficiency and accuracy of the credentialing process.
• Serve as the primary liaison between the organization and credentialing bodies, insurance networks, and regulatory agencies.
• Conduct periodic audits of provider files and credentialing databases to ensure compliance with internal and external standards.
• Respond to requests for information from insurance companies, licensing agencies, and other credentialing entities.
• Track and report credentialing metrics to leadership, identifying potential delays and providing solutions for process improvements.
• Stay updated on changes in credentialing regulations and payer requirements, ensuring continuous compliance.