Credentialing Specialist - Remote | Wfh

We are seeking a highly motivated and detail-oriented Provider Enrollment Specialist to join our dynamic team. As a Provider Enrollment Specialist, you will play a crucial role in ensuring the seamless enrollment of healthcare providers into our network. Your primary responsibility will be to establish and maintain effective relationships with providers, office managers, billing departments, and payers, while overseeing the enrollment process to guarantee compliance with regulatory guidelines.

At [Company Name], we foster a supportive and collaborative work environment that values your contributions and offers opportunities for professional growth. Join our team and embark on an exciting journey where your skills and dedication will be recognized and rewarded.

Responsibilities

Facilitate the timely establishment and linkage of provider numbers to the appropriate OHMG group entity, tracking progress and ensuring completion.

Communicate established provider numbers to professional billing for claims processing and clinic managers for patient scheduling.

Collaborate with the finance department to identify patient population needs and target payers for contracting purposes.

Manage each provider's Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) accounts.

Cultivate strong working relationships with providers, office managers, professional billing teams, and payer contacts.

Actively participate in onboarding and network representative meetings to contribute to the growth and success of the organization.

Maintain accurate provider enrollment information in the credentialing database, generating reports as needed for various stakeholders.

Review applications for completeness and assemble credential files for submission to government and commercial payers.

Identify and address any credentialing red flags in collaboration with OHMG managers and directors.

Keep track of provider licensure, certificate of insurance, and network expirations using a centralized calendar system.

Submit Annual Disclosures of Ownership (ADOs) and re-validations to Medicare and Medicaid for all providers and practices.

Manage the credentialing and re-credentialing process for all OHMG providers based on established network schedules.

Provide guidance and support to OHMG providers, clinic directors, and office managers on the credentialing and enrollment processes.

Required Qualifications

Associate's Degree (or higher) OR 4+ years of experience in payor enrollment within the healthcare industry.

2+ years of experience in payor enrollment within healthcare, covering government, state, and commercial payors.

Proficiency in managing CAQH, PECOS, and National Provider Identifier (NPI) accounts, with at least 1 year of experience.

Familiarity with NCQA and JACHO guidelines, with a minimum of 1 year of experience.

Experience in credentialing and re-credentialing providers according to network-specific time schedules.

Intermediate proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.

Preferred Qualification

Previous experience with MD staff software.

Employment Type: Full-Time

Salary: 100K - 150k yearly