Credentialing Enrollment Specialist

Overview

Primary purpose:

Oversees the internal processes and procedures and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning, development, and organization.

Major responsibilities:

Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of providers.

Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for providers.

Enters provider data in the database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.

Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.

Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.

Conducts practice site visits for practices within.

Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.

Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting demographics and participation.

Provides Team member support to the Credentialing and Quality Committee.

Job Requirements:

Must be a Georgia resident or be open to relocation.

High school diploma or GED required. Bachelors degree preferred.

Three (3) years experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is required.

Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone required. Experience in typing, word processing, and business correspondence is required.

Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.

#Indeed456