3Rd Party Payor Enrollment Specialist

PopHealthCare is currently seeking a Full-time 3rd Party Payor Enrollment Specialist. At PopHealthCare, our mission is simple to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people! We need sharp and nimble people to join our growing team!

Job Summary: The 3rd Party Payor Enrollment Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. The 3rd Party Payor Enrollment Specialist facilitates all aspects of PopHealthCares credentialing, including initial appointment, reappointment, expirables process, as well as the credentialing/enrolling of providers for health plan clients.

The 3rd Party Payor Enrollment Specialist ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. The 3rd Party Payor Enrollment Specialist is also responsible for the accuracy and integrity of the credentialing system and related applications.

Essential Job Functions:

• Tracks requirements and timeline for re-credentialing.
• Alerts clinicians of re-credentialing requirements based on internal and external standards.
• Organizes credentialing process to meet required timelines.
• Submits credentialing files to health plans.
• Supports PopHealthCare processes for state regulatory requirements for nurse practitioners and physician assistants.
• Obtains, verifies, and analyzes all required information pertinent to internal and external credentialing.
• Schedules and supports internal Credentialing Committee meetings.
• Supports PopHealthCare processes to assure licensure and certification are maintained
• Adheres to PopHealthCare credentialing policies and standard operating procedures.
• Maintains credentialing files in organized fashion.
• Educates and supports clinicians in completing the credentialing process.
• Submits files for internal credentialing to the Credentialing Committee.
• Interfaces with health plan contacts to understand and support the credentialing application and completion process.

Requirements:

• Certification as a Medical Credentialing Specialist preferred
• Experience in use of the Council for Affordable Quality Healthcare (CAQH), Universal Provider Datasource (UPD) for credentialing support
• Previous experience in credentialing of physicians, nurse practitioners, or physician assistants (minimum of 2 years preferred)
• High School diploma, GED or equivalent required
• Knowledge of NCQA requirements with survey experience preferred
• Ability to use computer systems including but not limited to Word, Excel, and credentialing software
• Associates Degree in health care or business administration preferred

PopHealthCare is an equal opportunity/equal access employer fully committed to achieving a diverse workforce.