Credentialing and Enrollment Specialist

3 months ago


New Orleans, United States Tulane University Staff Full time

Responsible for all activities related to enrollment/credentialing and re-enrollment/ re-credentialing of all physicians in contracted Managed Care and Governmental Health Insurance Plans. Provide Management with the necessary data required in the negotiation of new contracts. Works with Business Services Staff in the resolution of provider enrollment/credentialing issues. Works in a highly complex environment with a multiple level of staff, management, and physicians. Work with large volumes of data. Meets initial deadlines and follow up deadlines consistently. Interfaces with TUHC and credentialing vendors for delegated credentialing.

•Excellent oral and written communication skills.
•Ability to work effectively with physicians and their staff member.

•Detail oriented with above average organizational skills in planning and prioritizing to meet deadlines

•Must be fluent in the use of Excel and Word and Internet use

•Knowledge of provider credentialing and its direct impact on the group's revenue cycle

REQUIRED BACKGROUND CHECK, PHYSICAL, AND DRUG SCREENING FOR INCUMBENTS WHO HAVE CONTACT OR EXPOSURE TO ANIMALS OR ANIMAL TISSUES:

Selected candidates must complete and pass a background check and an occupational health screening as a condition of employment. For identified jobs, a drug screening will also be required. The background investigation, required occupational health screening, and any required drug screening will be conducted after a conditional employment offer has been extended.

•High School Diploma
•5 years Credentialing and Enrollment work experience

•Familiarity with Managed Care Health Insurance Plans, especially credentialing procedures.
•Experience with government payers, especially Provider Enrollment guidelines.
•Excellent knowledge of required documentation for provider credentialing to Hospital Services

•Corporations and other outside credentialing agencies

•Ability to complete and maintain staff rosters with new enrollment and terminated providers for over 500+ providers



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