Provider Enrollment Specialist

i3 Verticals Management Services, Inc.

Metairie, LA

Full-Time

Job Description

JOB TITLE: Provider Enrollment Specialist/Credentialing
SUPERVISION RECEIVED: Reports to Provider Enrollment Manager.

LOCATION: Metairie, LA

GENERAL SUMMARY OF DUTIES: Responsible for all aspects of the credentialing, re-credentialing, and contracting processes for medical providers in private practice or group settings.

ESSENTIAL FUNCTIONS:

Prepare and submit Governmental and Private Carrier applications for initial submission and re-credentialing and follow-up as needed.
Acquire and process new Managed Care Agreements.
Maintain detailed log of all pending and completed work.
Apply and update NPI Numbers through the NPI Website.
Apply and maintain EDI, EFT & ERA processes.
Maintains strictest confidentiality.
Follows established policies and procedures listed in the Employee Handbook, ACS Practice Management, Compliance and HIPPA Manuals.
The job holder must demonstrate competencies applicable to the job position while performing duties in a professional and courteous manner.

EDUCATION:

High school diploma or GED.

SKILLS & KNOWLEDGE:

Knowledge and understanding of the credentialing/enrollment process.
Knowledge of Governmental and Private Provider enrollment processes and applications for Louisiana and other States.
Knowledge of CMS Federal and State Guidelines.
Knowledge of Prime Source Verification.
Knowledge of CAQH.
Proficient use of Microsoft Office Word, Excel, and Outlook.
Knowledge of grammar, spelling and punctuation to type correspondence.

ABILITIES:

Ability to read, understand and follow oral and written instruction.
Ability to sort and file materials correctly by alphabetic or numeric systems.
Ability to organize and prioritize work and manage multiple priorities.
Ability to communicate clearly and concisely.
Ability to establish and maintain effective working relationships with patients, employees and the public.