Professional, Provider Enrollment (Multiple)

Professional - PES

 2-4 Years of experience in end-to-end process of Provider Enrollments/ Insurance Credentialing, Provider Contracting, and Re-Credentialing.

 Strong knowledge of US Credentialing

 Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle.

 Adhere to organizational policies and procedure.

 Ability to prioritize and manage work queue.

 Knowledge of Microsoft Office (Word, Excel, Outlook).

 Excellent written and verbal communications. Essential Functions

 Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.

 Maintain internal provider grid to ensure all information is accurate and logins are available.

 Update each provider’s CAQH database file timely according to the schedule published by CMS.

 Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid etc.

 Maintains knowledge of current health plan and agency requirements for credentialing providers.

 Sets up and maintains provider information in online credentialing databases and system.

 Tracks license and certification expirations for all providers to ensure timely renewals.

 Ensures practice addresses are current with health plans, agencies, and other entities.

 Store the documents centrally on our secure document management systems.

 Periodic update of the document library for credentialing purpose.

 Maintain strict confidentiality in accordance with HIPAA regulations and company policy.

 Meeting daily/weekly and monthly targets set for an individual