Health Care Payer Credentialing/Enrollment Specialist

Payer Credentialing/Enrollment Specialist

JOB TITLE: Payer Credentialing/Enrollment Specialist

POSITION SUMMARY:

Responsible for day-to-day Credentialing Services tasks to include payer enrollment, revalidations, and other miscellaneous tasks as required by payers; serves as point of contact for providers, groups and facilities, with insurances and other related entities.

RESPONSIBILITIES:

·        Work with contracted providers, group and/or facilities to meet credentialing service expectations

·        Complete the processes to enroll and credential providers (physicians, groups, facilities, physician assistants, nurse practitioners, CRNAs, etc.) with insurance payers while meeting payer criteria

·        Complete the processes to recredential existing providers, groups and/or facilities

·        Gather and maintain current data and documents for all providers in accordance with policy and procedures

·        Follow up with clients and payers for timely credentialing processes

·        Clearly and effectively communicate with providers, operations managers, and insurance companies, handling basic questions dealing with the day-to-day operation of credentialing and enrollments

·        Review and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information

·        Knowledge of navigating and data entry of applications and spreadsheets

·        Knowledge of provider and payer credentialing, accreditation, insurance regulations, policies, guidelines and standards

·        Other duties as assigned

REQUIRED QUALIFICATIONS:

·        High school degree or equivalent required

·        Associate degree in business healthcare related field preferred or equivalent work experience

·        Minimum of 2 years’ experience in payer enrollments, credentialing, and privileging, with heavy emphasis on payer enrollment experience (PESC, CPCS, and/or CPMSM preferred)

TRAITS AND APTITUDES:

·        High level of awareness of pertinent details; excellent organization skills

·        Strong analytic and problem-solving abilities

·        Excellent verbal and written communication skills

·        Ability to handle daily pressure and stress related to tight deadlines

·        Must maintain confidentiality always

·        Professional demeanor

·        Excellent computer proficiency and skills with PC software (Microsoft Office Excel, Word, Power Point, OneDrive, Smartsheet), with the ability to quickly master programs necessary for the position

·        Must be able to work independently and remotely

·        Strong ability to manage time regarding tasks, turnaround time, and work/home time balance as a remote employee

·        Honesty and strong moral compass

SALARY:

Salary range is $22/hour to $25/hour depending on experience.

BENEFITS:

·        Flexible schedule

·        Remote work

·        Vacation pay

·        Holiday pay

SCHEDULE:

·        40 hours per week

WORK LOCATION:

Remote work (work from home)