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Provider Enrollment Specialist

2 months ago

Baltimore, Maryland, United States Three Point Solutions Full time
Position Overview

Job Title: Credentialing Coordinator (Hybrid)

Company: Three Point Solutions

Contract Duration: 6 Months

Location: Remote

Key Skills Required:

  • Advanced Excel proficiency
  • Expertise in Credentialing processes
  • Strong Customer Service abilities
  • Effective Written Communication

Role Purpose:

  • To credential healthcare providers for participation in the network. Ensure the accuracy of provider data to comply with industry regulations, accreditation standards, and organizational policies.

Core Responsibilities:

  • 40% Review and assess credentialing applications to confirm qualifications for network inclusion. Identify suitable networks and secure necessary agreements.
  • 30% Address inquiries related to provider eligibility, credentialing status, and updates. Ensure prompt resolution and take proactive measures.
  • 15% Maintain comprehensive provider records, updating information during the credentialing and recredentialing processes.
  • 10% Detect, analyze, and rectify issues within provider files. Verify data integrity and facilitate successful system integration.
  • 5% Draft written communications and engage effectively to gather any missing information.

Qualifications:

  • Education: High School Diploma required
  • Experience:
    • Minimum of 3 years in physician credentialing or health insurance/managed care operations
    • Experience in customer service, claims processing, billing, enrollment, or call center environments

Preferred Qualifications:

  • Bachelor's Degree in Business, Healthcare Administration, or a related discipline

Knowledge, Skills, and Abilities (KSAs):

  • Proficient in Excel, including advanced functions such as Pivot tables
  • Exceptional verbal and written communication skills
  • Ability to cultivate and sustain effective professional relationships
  • Familiarity with medical terminology
  • Competence in utilizing reference materials and adhering to standard operating procedures
  • Awareness of jurisdictional requirements and legal implications

Certifications:

  • Certified Provider Credentialing Specialist (CPCS) is preferred