Note: The job is a remote job and is open to candidates in USA. Family Allergy & Asthma is an allergy and asthma practice group providing patient-centered allergy and immunology care across multiple states. The Credentialing & Enrollment Analyst I manages credentialing, provider enrollment, re-credentialing, revalidation, and hospital privilege processes for providers while coordinating with insurance companies, hospitals, and healthcare entities to maintain regulatory compliance and reimbursement eligibility.
Responsibilities
- Communicate with new provider to obtain documentation necessary for credentialing & provider enrollment processes
- Create/Update required credentialing/enrollment portals
- Medical Licensure – ensure active medical licensure respect to provider assigned regions
- Board certification – ensure active board certification for related provider specialty
- Malpractice – complete malpractice application, obtain signatures submit to contact
- CAQH, Availity, CMS Systems – Update will all current accurate related data
- Provider Enrollment – Insurance Plan Participation; Complete provider enrollment applications
- Ensure timely follow-up procedures, throughout enrollment process
- Complete re-credentialing and revalidations requests prior to deadlines, ensure re-approval is achieved
- Hospital Privileges – Work in step with provider and hospital medical staff office completing application processes
- Initial privileges – Complete applications for physicians
- Re-Appointments – Complete reappointment applications
- Dues and Application fees – Submit requests for payment to accounting via MyStampli system or pay by credit card
- Excel Spreadsheets – Update various related excel sheets related to assigned providers such as Provider Credentialing; Provider Enrollment Tracker; Onboarding Checklist; Provider Insurance ID/PTAN; Hospital Affiliations; Provider NPI/License/DEA; Government Plan Revalidation; Standard Roster Templates; Current Locations; Malpractice; RCM Claims issues
- Maintain active list of providers with medical society/board memberships and process related dues/fees yearly
- Work shared email box with team members and respond or complete requests related to assigned providers
- Reminder System – Notifications routed to team via HER-Medical Management system. Review daily and complete requests as required
- RCM – Claims issues - assist in resolving claims issues that are provider enrollment related, which involves communication with the various insurance companies
- Work notifications from RCM related to Checks from carriers being sent to wrong “pay to” address
- Special Projects - complete any special assignments requested by Sr. Analyst or Payor Relations Manager
- Other duties as assigned
Skills
- Ability to fluently speak and read English
- Ability to read and interpret documents such as safety rules, handbooks, policies, and procedure manuals
- Ability to communicate effectively, verbally and written, with all levels of staff and patients
- High School Diploma or equivalent
- Minimum of 2 - 3+ years of provider initiated “submission” level of provider enrollment and credentialing experience in any of the following states (AR, FL, IL, IN, KY, MO, OH, PA, TN)
- Attention to detail and strong organizational skills
- Knowledge of healthcare regulations & payor enrollment processes
- Excellent communication skills (oral & written) to coordinate with providers, payers, medical staff offices, and other Family Allergy department team members
- Proficiency in MS Office (Excel, Word, Outlook, TEAMS) & Adobe (edits, printing, saving, routing)
- Proficiency in various Payor portals (Availity, CAQH)
- Ability to work independently and manage multiple tasks with minimal supervision
- Basic computer skills and understanding of modern office practices
- Florida credentialing & provider enrollment application experience preferred
Benefits
- This position offers the flexibility to work either fully onsite or remotely.
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