Job Description:
• Administer the provider credentialing process for practice providers and the provider enrollment process for insurance payers.
• Ensure timely communication with practices and implementation teams to gather credentialing and enrollment information.
• Process initial and re-credentialing applications and conduct primary source verification (CAQH, NPPES, etc.).
• Credential, link, and revalidate providers and groups with commercial and government payers.
• Maintain working knowledge of payer credentialing policies, forms, and compliance requirements.
• Troubleshoot and resolve enrollment issues, including claim denials and unbilled problems.
• Maintain accurate provider participation (PAR) lists and distribute updates to stakeholders.
• Enter provider demographics and credentialing data into credentialing software.
• Complete and track clearinghouse applications for EDI and ERA, and process EFT authorizations for payments.
• Collaborate with internal teams to develop and refine enrollment policies and procedures.
• Drive continuous improvement and contribute to special projects as needed.
Requirements:
• Associate or Bachelor’s degree in Healthcare Administration or related field preferred.
• CPCS (Certified Provider Credentialing Specialist) preferred.
• Minimum 3+ years of experience in healthcare payer enrollment and provider credentialing within a multi-specialty medical group.
• Experience working with government agencies such as CMS and AHCA strongly preferred.
Benefits: