Payer Enrollment Specialist

Payer Enrollment Specialist - Patient Financial Experience * Days - 40hrs/wk

Shift: Days

General Summary:

The Provider Credentialing Specialist maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. The Provider Credentialing Specialist creates and carries out various credentialing processes in relation to physicians, and other healthcare professionals. This role processes applications and reappointment paperwork, checking for full completeness and accuracy. The Provider Credentialing Specialist collects and processes verification and accreditation information, and updates database(s) for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. The Provider Credentialing Specialist prepares his/her own records for regular auditing, as well as maintaining close communication with the billing departments and all appropriate practitioners to ensure that records are up-to-date and consistent.
Requirements:

• High school diploma or equivalent.
• Associates degree preferred.
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Two (2) years of relevant credentialing and/or healthcare experience.
• Knowledge of Microsoft Office (Excel, Word, Power Point, Access).
• Excellent customer service skills and willingness to be a team player.
• Excellent written and verbal skills are required, with emphasis on attention to detail.
• Ability to meet daily, weekly and/or monthly deadlines.
• Ability to organize and prioritize work and manage multiple priorities .
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Essential Functions and Responsibilities:

1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage, CLIA licenses and any other required credentialing documents for all providers and facilities.
4. Maintains knowledge of current health plan and agency requirements for credentialing providers.
5. Apply for and maintain National Provider Identifier for all new and existing Providers.
6. Ensures practice addresses are current with health plans, agencies and other entities.
7. Maintains clear, consistent communication with the billing departments to resolve claims issues related to credentialing denials.
8. Tracks license, DEA, CAQH, and professional liability expirations.
9. Audits health plan directories for current and accurate provider information.

Requisition #: req8550