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Credentialing and Enrollment Specialist
3 months ago
CAMCARE HEALTH CORPORATION
Job Description
CREDENTIALING AND ENROLLMENT SPECIALIST
Who we are: CAMcare Health is a diverse and innovative team motivated to
provide the best possible healthcare to communities in Camden and the surrounding areas. We live our values by providing primary health care to everyone regardless of their ability to pay at seven sites throughout Camden and Gloucester counties. Focused on leveling up patient care, we are incorporating technology, creative problem solving, and innovating healthcare every day.
How you can make an impact: As a Credentialing and Enrollment Specialist, you will be responsible for ensuring that healthcare providers are properly credentialed and enrolled with insurance companies and government healthcare programs. You will play a crucial role in maintaining compliance with regulatory standards and ensuring that healthcare services can be reimbursed efficiently. This position requires meticulous attention to detail, excellent organizational skills, and a strong understanding of healthcare regulations and insurance processes.
What you will do:
Credentialing Process:
- Manage the credentialing process for healthcare providers, including physicians, nurses, and other allied health professionals.
- Collect and verify all necessary documentation for credentialing applications.
- Communicate with providers to obtain any missing or updated information.
- Submit credential applications to insurance companies and other relevant entities.
- Monitor the status of credentialing applications and follow up as needed to ensure timely completion.
- Review regulatory and disciplinary action reports issued by State licensure bodies, Federal agents and the Office of Inspector General Medicaid and Medicare Sanctions report (OIG), National Practitioner Data Bank (NPDB) reports; identify providers that appear in our database and invoke the appropriate process as defined in policy and procedure.
Enrollment Management:
- Facilitate the enrollment of healthcare providers with insurance plans and government healthcare programs, such as Medicare and Medicaid.
- Complete enrollment applications accurately and in a timely manner.
- Coordinate with insurance carriers and government agencies to resolve any enrollment issues or discrepancies.
- Maintain up-to-date knowledge of enrollment requirements and procedures for various payers.
Compliance and Regulations:
- Ensure compliance with all regulatory requirements related to credentialing and enrollment, including HIPAA regulations and state licensing requirements.
- Stay informed about changes in healthcare regulations and update credentialing and enrollment processes accordingly.
- Develop and maintain policies and procedures to ensure compliance with industry standards.
Database Management:
- Maintain accurate and up-to-date provider information in credentialing and enrollment databases.
- Track expiration dates for licenses, certifications, and other credentials.
- Generate reports and provide analysis related to credentialing and enrollment activities as needed.
Collaboration:
- Collaborate with internal teams, including billing, coding, and provider relations, to ensure seamless coordination of credentialing and enrollment processes.
- Serve as a resource to providers and internal staff regarding credentialing and enrollment inquiries.
Report and assist with special projects or Human Resource related duties as assigned by the Director of Human Resources.
Who you are and the expertise you bring:
- Bachelor's degree in healthcare administration, business administration, or related field (preferred).
- Previous experience in healthcare credentialing and enrollment, preferably in a medical practice, hospital, or healthcare organization.
- Strong understanding of healthcare regulations, including HIPAA, Medicare, and Medicaid.
- Excellent communication skills, both written and verbal.
- Proficiency in using credentialing and enrollment software applications.
- Ability to prioritize tasks and manage multiple projects simultaneously.
- Attention to detail and accuracy in data entry and documentation.
- Ability to work independently and as part of a team in a fast-paced environment.
- Certification in healthcare credentialing (e.g., Certified Provider Credentialing Specialist, CPMS) is a plus.
Reasonable accommodations may be made to enable individuals with disabilities to perform their essential functions, as required under the Americans With Disabilities Act ("ADA") or other applicable state/local law.
CAMcare Health Corporation is an Equal Opportunity Employer
Benefits:
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Retirement plan
- Vision insurance
