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Credentialing and Enrollment Specialist

  • Job Number 529264
  • Type Temp
  • Location Stamford, CT
  • Pay Depends On Experience
  • Referral Bonus $50

Credentialing and Enrollment Specialist

Job Description:

Stamford, CT-based healthcare facility looking to hire a Temporary Credentialing and Enrollment Specialist.

The position is fully remote; however, candidates must reside in CT or NY to be considered.
Temporary Credentialing & Enrollment Specialist:
• Hours: 8 am - 4:30 pm, M-F
• Duration: 3+ month assignment for additional support during the team's enrollment project.

JOB SUMMARY:
The Credentialing and Enrollment Specialist performs administrative and technical duties requiring accuracy and attention to detail involved in the enrollment and re-enrollment healthcare providers with all third party and government payors with whom there are contracts or agreements for the reimbursement of services. This position has continuous contact with internal and external customers including physicians and other healthcare providers, administrators, support staff and payor representatives.

MAJOR ACCOUNTABILITIES / CRITICAL RESPONSIBILITIES:

1. Assemble, organize, and present factual provider information derived from a variety of original and secondary sources.
2. Accurately complete the enrollment/reenrollment/update processes as outlined by each payor for all appropriate healthcare providers to ensure timely and continued provider network participation.
3. Maintain detailed provider credential and enrollment records and electronic files.
4. Maintain thorough documentation of each stage of the enrollment/reenrollment/update process. Provide for timely and thorough follow up of pending applications.
5. Accurately update and maintain all internal systems and resources with appropriate provider and network participation information.
6. Communicate provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered.
7. Advise Provider Enrollment & Onboarding Manager of any potential delays in a provider credentialing.
8. Assist with the onboarding of incoming providers.
9. Complete accurate and timely CAQH initial attestations and re-attestations.
10. Review, update and submit demographic rosters to payers to meet ACA compliance requirements.
11. Map enrollment applications as needed.
12. Process department projects such as mass enrollments, group information updates or new plan enrollment.
13. Maintain required confidentiality concerning privileged information within the department.
14. Develop and maintain good working relationships with the organizations providers and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process.
15. Develop and maintain relationships with Payor Representatives to facilitate the provider enrollment/reenrollment processes.
16. Respond to and resolve problems with provider numbers and/or participation status as it relates to denial of services or reimbursement by working closely with all levels of administrative and clinical personnel and payor representatives.
17. Supports the Manager in the development of departmental policies, workflows, processes, and systems.
18. Performs other related duties as assigned or requested to maintain a high level of service.
19. Completes required continuous training and education, including department specific requirements.
20. Demonstrates professional work behavior Service Standards and Code of Conduct.
21. Complies with departmental organizational policies and procedures and adheres to external agency requirements.
22. Efficiently manages assigned projects from beginning to conclusion.

Requirements:

QUALIFICATIONS/REQUIREMENTS:
  • High school required. College degree preferred.
  • Three or more years of experience working in physician credentialing and/or enrollment preferred.
  • Working knowledge of credentialing, provider enrollment processes, requirements, and terminology for commercial insurance companies and government-sponsored plans, e.g., Medicare and Medicaid, as well as relevant terminology a plus.
  • Familiarity with provider credentialing documents, i.e., licensure, medical school and training documentation, board certifications, etc.
  • Strong organizational, analytical and problem-solving skills.
  • Ability to manage multiple work streams simultaneously using good planning, organization, multi-tasking, and prioritization to meet deadlines.
  • Ability to work independently while contributing to a team environment; ability to make sound and timely decisions.
  • Ability to quickly and independently adapt to changing deadlines, workflows, and processes.
  • Effective interpersonal skills with the ability to interact with all levels of management, staff, and providers.
  • Demonstrated ability to effectively communicate in writing and verbally; excellent presentation skills.
  • Demonstrated computer skills; proficient with MS Windows applications including but not limited to Word, Excel, and Outlook. Experience working with credentialing software is a plus.
  • Demonstrated ability to conduct Internet-based research to identify credentialing and enrollment documents, guidelines, and instructions.