Healthcare Credentialing and Enrollment Specialist
Remote
Integrated Programs – Operations /
Full-Time /
Remote
We are seeking a detail oriented and experienced Healthcare Credentialing and Enrollment Specialist to join our team. You will play a crucial role in ensuring that our healthcare providers are credentialed and enrolled with various insurance plans, enabling seamless patient care and reimbursement processes
How you will make an impact
- Credentialing Process Management: Manage the credentialing process for healthcare providers, including physicians, nurse practitioners, and allied health professionals.
- Enrollment with Insurance Plans: Initiate and complete enrollment applications with various insurance plans and networks.
- Verification and Documentation: Verify provider credentials, licenses, certifications, and relevant documentation required for credentialing and enrollment.
- Managing Multiple Deadlines: Prioritize and manage multiple credentialing and enrollment deadlines effectively to ensure timely provider participation in insurance networks.
- Communication and Engagement: Foster positive relationships and effectively engage with healthcare providers to facilitate necessary credentialing and enrollment activities.
- Update Provider Profiles and Rosters: Maintain and update provider profiles and rosters with accurate information regarding credentials, affiliations, and insurance participation.
- Compliance: Ensure compliance with all regulatory requirements and standards related to credentialing and enrollment.
- Database Management: Maintain accurate and updated provider information in credentialing and enrollment databases.
- Problem Resolution: Address and resolve issues related to credentialing and enrollment, such as application denials or delays.
- Lead a team of credentialing specialists, train administrative assistants, and develop efficient workflows to ensure timely completion of multiple projects.
What we are looking for
- Bachelor’s degree in Healthcare Administration, Business Administration, or related field (or equivalent work experience).
- Experience: Minimum of 3 years of experience in healthcare credentialing and enrollment.
- Strong knowledge with credentialing standards, regulations, and procedures. Proficiency in using credentialing software and databases.
- Strong organizational skills with the ability to manage multiple deadlines and priorities. Excellent communication and interpersonal skills. Ability to engage and collaborate effectively with healthcare providers.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
- Experience working in a healthcare setting, such as a hospital, clinic, or healthcare management organization preferred.
- Familiarity with Medicare, Medicaid, and commercial insurance plans preferred.
- Expert knowledge navigating Medicaid state websites, provider enrollments and ID updates, and group enrollments preferred.
