Provider Credentialing Professional

Provider Credentialing Specialist Job Description

We are seeking a highly motivated and detail-oriented Provider Credentialing Specialist to join our organization. The ideal candidate will possess a strong background in provider enrollment and a comprehensive understanding of the credentialing process.

This role is crucial for ensuring timely and accurate submission of provider applications, facilitating smooth onboarding, and maintaining compliance with all relevant regulations.

Key Responsibilities:

• Provider Enrollment & Application Management:
• Demonstrated expertise in the end-to-end provider enrollment process.
• Proficiency in accurately completing a high volume of provider applications across various specialties and payer types.
• Ensuring timely and efficient submission of all completed applications to relevant entities.
• Tracking application statuses and proactively following up on outstanding items to expedite approval.
• Welcome Kit Generation & Contract Loading:
• Responsible for the creation and dissemination of comprehensive Welcome Kits for new providers, ensuring all necessary documentation and information is included.
• Accurate and efficient loading of provider contracts into the designated system, ensuring all terms and conditions are correctly captured.
• Application Portal Expertise:
• Extensive experience in creating and managing accounts within key healthcare application portals, including:
• CAQH (Council for Affordable Quality Healthcare): Establishing and maintaining provider profiles for efficient data sharing.
• Medicaid: Navigating state-specific Medicaid enrollment processes.
• Medicare (PECOS portal): Submitting and managing Medicare enrollment applications through the Provider Enrollment, Chain and Ownership System.
• NPI (National Provider Identifier): Assisting providers in obtaining and managing their NPI numbers.
• Regional Credentialing Advantage:
• Experience working with providers specifically in Florida will be considered a significant advantage, demonstrating familiarity with state-specific regulations and payer requirements.
• Communication & Responsiveness:
• Maintain a high level of professionalism and responsiveness in all email communications, promptly addressing queries and providing clear, concise information to internal and external stakeholders.
• Compliance & Confidentiality:
• Strictly adhere to all HIPAA regulations and maintain the utmost confidentiality of sensitive patient and provider information.
• Ensure all credentialing activities are in full compliance with federal, state, and organizational guidelines.

Required Skills and Qualifications

• Education:
• Bachelor's Degree in a relevant major such as Healthcare Administration, Health Information Management (HIM), Business Administration, or Public Health.
• An associate's degree combined with relevant work experience may suffice for entry-level roles.
• Experience:
• Expertise in provider enrollment and credentialing processes, ensuring ethical and accurate completion and submission of applications across various specialties and payers.
• Proficiency in managing accounts in CAQH, Medicaid, Medicare (PECOS), and NPI portals with a commitment to ethical standards in data handling.
• Technical Skills:
• High proficiency in Google Sheets and Google Docs, supporting a high-performance culture through efficient workflows.
• Excellent typing skills for precise data entry.
• Strong knowledge of operating systems, software, and browsers to uphold professional performance standards.
• Compliance & Ethics:
• Strict adherence to HIPAA and federal/state credentialing guidelines, ensuring ethical conduct in all processes.
• Maintain confidentiality of sensitive information with unwavering integrity.

Benefits

• The ideal candidate will possess a strong background in provider enrollment and a comprehensive understanding of the credentialing process.
• This role demands a detail-oriented professional with a strong ethical foundation, technical proficiency, and a drive for performance excellence in credentialing.

Others

• Florida experience is a plus.

This role is an exciting opportunity for a skilled and detail-oriented professional to contribute to the success of our organization.