Credentialing and Enrollment Specialist

2 weeks ago

Lakeland, United States Watson Clinic Full time

**Required Education and Experience**:High school graduate. Two-year degree from an accredited college or university is preferred, but not required. CPCS or CPSMS Certification preferred. Reporting and analytic background a plus.***

**Preferred Education and Experience**:Critical thinking and analysis of provider data; ability to research applicable regulations and statues; high degree of accuracy and attention to detail; ability to assist in process innovation and improvement; understanding of clinic entity structures; excellent organizational, time management and communications skills; ability to use and engage in internet research and other technology skills. Experience in credentialing, healthcare provider enrollment or contracting/compliance. CPCS certification to be obtained when eligibility requirements have been met (minimum 3 years credentialing experience).

**Additional Eligibility Qualifications**:Proficiency in Microsoft Word, Excel, PowerPoint and Adobe. Familiarity with websites - Provider Enumeration System (NPPES) Officer of inspector General database (OIG), Identity & Access Management System (I&A), Provider Enrollment, Chain, and Ownership System (PECOS) and others.

**Summary/Objective**:Responsible for the day to day coordination and completion of the credentialing and provider enrollment for medical providers.

**Essential Functions**

Performs monthly audits of Cactus database to ensure correct information is entered by credentialing specialists for practitioners.

Assists in the maintenance of all practitioners’ credentials files, assuring that all mandatory documents are current and on file.

Provides training or serve as an advisor/mentor to new department members. Provides training in Cactus to other departments as applicable.

Assists in resolution of enrollment issues, internal and external. Prepares rosters and reporting information as requested by departments and payers..

Assists in the preparation of appointment/reappointment letters and delineation of privileges for practitioners.

Cross trains on department items to cover as needed.

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