Credentialing/ Enrollment Specialist
Summary: Coordinates and facilitates the enrollment of Alder Health Services professional providers (medical and behavioral health) with various payers for professional services requirements. Reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payers’ requirements. Obtains information from professional providers and other sources. Completes timely application processes based on payer specific formats. Continually follows up on enrollment and/or credentialing statuses until complete. Resolves issues as they are identified in a timely manner. Maintains systems/ applications used in the enrollment processes.
Completes provider payer enrollment/ credentialing and recredentialing with all identified payers in a timely manner. Handles highly sensitive and confidential information regarding professional providers.
Resolve enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting insurers and others as identified. Maintains positive working relationships with providers. Plays an active role in explaining and informing providers and practice/ office managers of the submission requirements for credentialing/ recredentialing process, stressing the importance of compliance with these processes.
Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc. Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data.
Proactively obtains updated provider credentialing data prior to expiration. Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions. Completes all additions, updates, and deletions. Supports new provider onboarding processes related to enrollment.
Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes. Proactively communicate any changes regarding contracting as it relates to enrollment and operations.
Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible and transparent for executive inquiries or other information as deemed necessary by management.
Continuously search for process improvements to achieve accuracy and efficiency.
Perform other duties as assigned or required by management.
Work closely with billing specialists and assist when available.
Associate degree or 2+ years’ experience in a physician medical office with basic understanding of various payer billing requirements and claims processing and experience with payer credentialing/ enrollment requirements.
Advanced computer skills using word, excel, adobe and web-based applications.
Excellent customer service, follow-up, and communication skills.
Strong organizational skills.
Delegated credentialing experience
Attention to detail.
Analytical and writing skills.
Understanding of medical terminology.
Ability to communicate effectively with providers and staff members within an organization.
Understanding of laws and regulations in relation to credentialing/ enrollment.
Pay rate: $19.00-$21.00 per hour.
Position may become a hybrid schedule (in-office and remotely). Will need to be in-office initially. Monday through Friday 8:30am-5:00pm.