Provider Enrollment/Credentialing Specialist

DESCRIPTION:

This position will be responsible for credentialing new and established health care providers, and maintenance of information to include application completion, follow up, data collection, data entry, and document review. Depending on the skill set and experience of the candidate selected, there may also be the opportunity to perform billing duties.

RESPONSIBILITIES:

• Collect, update and maintain necessary provider information and documentation and verify the information where possible.
• Establish and maintain data entry in CAQH.
• Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner.
• Verify provider and group information with insurance companies (addresses, provider rosters, contracted plans, provider numbers, etc).
• Coordinate information for enrollment and terminations of all providers.
• Maintain good rapport and professional communication with Health Plan Representatives.
• Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states.
• Build strong working relationships with medical facilities and provider offices.
• Adhere to department policies and procedures including timely delivery of completed work and use of resources.
• Responsible for entering, updating, maintaining NPI and any other applicable provider numbers.
• Provide concise, timely communication to appropriate leadership regarding potential credentialing issues.
• Proactively share knowledge with colleagues.
• Perform analysis and appropriate follow-up of each initial application and reappointment.
• Work with physicians, professional staff and physicians' office staff to acquire necessary materials and information.