Credentialing Specialist

2 months ago

Milwaukee, United States ADVENT Full time
Job DescriptionJob DescriptionDescription:

Envision a place where you thrive. Envision an organization that believes in you as much as you believe in them. A place where your work has meaning. At ADVENT, you can have just that.


ADVENT embraces those who seek more and demand excellence from themselves and their employer. We invite you to be challenged, to challenge, and to embark on a journey where passion meets purpose. We’re not what you typically find in healthcare. We’re proud to be a team that does things differently, with a focus on finding solutions for our patients. We know we’re not for everyone and don’t claim to be perfect but our commitment to improvement is unwavering. We have the tenacity, creativity, and drive to find a better way – together - and always keep our patients at the forefront.


Are you ready to rediscover your professional purpose? Take the leap and join us on your journey towards success.


How you will make an impact as a Credentialing/Provider Enrollment Specialist:

  • Broaden ADVENT’s footprint by meticulously gathering, submitting, monitoring and maintaining complete and accurate provider information
  • Coordinate the procurement and ongoing monitoring of applicable licenses, DEA, Controlled Substance Certifications, and Collaborative Agreements.
  • Serve as primary point of contact and provide necessary guidance, to providers, on the payor enrollment and renewal process
  • Ensure all providers are actively enrolled with applicable payors and facilities to provide in-network services within the organization’s timelines, thereby creating a streamlined scheduling, authorizing, billing and reimbursement process
  • Work closely with expansion and payor contracting departments to facilitate the implementation of new payor contracts and ensure the provision of accurate provider information as requested (Provider roster, malpractice coverage information, etc.).
  • Collaborate with Payor Contracting, Director of Medical Affairs and individual providers to identify options and potential solutions to ensure appropriate hospital/ASC privileges, as required. Manage the completion and submission of initial and renewal facility applications and lead follow-up coordination with facility to a successful end.

What we're looking for in a Credentialling/Provider Enrollment Specialist:

  • 2-4+ years provider/insurance enrollment experience
  • Knowledge and ability to easily navigate and enroll billable providers in Medicare, Medicaid, and Commercial Insurance Plans/Networks
  • Knowledge of electronic databases and systems such as CAQH and PECOS
  • Ability to demonstrate strong research skills and gather pertinent information from verification sites
  • Ability to effectively communicate with multiple agencies, departments, and providers in a clear and timely manner
  • Ability to communicate needs timely and efficiently, comfortable using multiple sources of communication, and able to easily escalate urgent needs
  • Ability to work independently but also collaborate with team member
  • Display strong data entry and technology skills
  • Maintain knowledge in medical licensing and certification requirements

Why you should choose ADVENT:

  • Culture that embraces being kind, is solutions minded, and encourages you to ask questions
  • 22 days of PTO (prorated your first year based on start date) & holiday pay
  • Medical, dental, and vision insurance with generous employer paid HRA account
  • 401k contribution
  • Hybrid work model (work in office minimum 1/day week). * This role is a 32-hr/week schedule with flexible hours *

ADVENT Careers Website

Requirements:


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