Payer Credentialing Enrollment Specialist
Reporting to the Provider and Payor Credentialing Manager , the Payer Credentialing Enrollment Specialist is responsible for all aspects of the payer enrollment credentialing and re-credentialing processes with Medicaid, Medicare, Medicaid Managed Care plans, Commercial plans and Dental plans. The Provider and Payor Credentialing Manager for ensuring that all providers ae credentialed and contracted with health plans, as well as maintaining up-to-date information for each provider and group location. The Payer Credentialing Enrollment Specialist is responsible for following up with health plans to ensure reasonable plan panel approval.
ESSENTIAL JOB FUNCTIONS:
Essential functions of the job include, but are not limited to, organization, professionalism, strong written communication skills, relationship building, utilizing a computer for typing and research, and attend meetings when required.
- Perform the administrative and technical duties necessary to complete the payor enrollment process.
- Complete and review provider applications with accuracy and thoroughness, contact providers for application information when necessary, contact government agencies and managed care companies to obtain status and resolve discrepancies related to provider applications, and follow-up with physicians and assist with completing applications.
- Complete regular follow up with the payers to ensure applications are being processed. Maintain internal productivity reporting as directed by the Provider and Payor Credentialing Manager.
- Act as liaison between Provider and Payor Credentialing Manager and payers, identify delays with payers, escalate and communicate delays or issues timely to internal business units, including Healthcare Operations, Revenue, and Medical Staff leadership.
- Ensure timely submissions of all re-appointments and re-credentials, verifies all licenses are current, and maintain internal files, including copies of current credentials.
- Follow-up and communicate regularly with management and Billing/Revenue department
- Maintain accuracy of and update CAQH database.
- Provide superior customer service at all times to internal and external contacts including customers, providers, representatives, and co-workers.
- Other duties as assigned.
Knowledge, Skills, Abilities and other Qualifications:
- High School diploma or equivalent. Some college preferred.
- 1-2 years’ experience in credentialing with a strong background in payer enrollment/credentialing for physicians and mid-level practitioners.
- Strong computer skills, spreadsheet and database management.
- Ability to work independently and under pressure.
- Have the ability to adapt to change.
- Strong attention to detail, accuracy and thoroughness are essential.
- Ability to develop a rapport with staff in order to provide them with a realistic payer credentialing process.
- Strong written and verbal communication is a must.
- Familiar with Medicaid and Medicare enrollment procedures and protocols for physician and mid-level credentialing preferred.
- Knowledge and experience with the diversity of the gay/lesbian/bisexual/transgendered community required.
- Must have sensitivity to, interest in and competence in cultural differences, HIV/AIDS, minority health, sexual practices, and a demonstrated competence in working with persons of color, and gay/lesbian/bisexual/transgendered community.
- Proficiency in all Microsoft Office applications and other computer applications required.
- Must have reliable transportation and valid Ohio driver’s license.
Hours are varied including some evenings and weekends. Background and reference checks will be conducted. In accordance with Equitas Health’s Drug-Free Workplace Policy, pre-employment drug testing will be administered. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment.