Provider Enrollment and Credentialing Specialist

2 weeks ago

Chicago, Illinois, United States Balance Health Full time
About Balance Health

Balance Health is dedicated to enhancing the quality of life for individuals by improving and sustaining mobility. We achieve this by uniting top-tier podiatrists, orthopedic surgeons, vascular surgeons, and physical therapists, equipping them with the essential tools and resources to provide outstanding patient care. This commitment has positioned us as the fastest-growing Physician Practice focused on lower-extremity care.

Under the guidance of the Credentialing Manager, the Credentialing and Provider Enrollment Coordinator will be tasked with:
  • Facilitating prompt communication with the Practice and implementation teams to gather necessary credentialing and provider enrollment details.
  • Overseeing the hospital credentialing process for practice providers and managing the provider enrollment process for insurance payers.
Key Responsibilities:
  • Manage initial and re-credentialing applications for providers across various payers, hospitals, and surgery centers.
  • Perform primary source verification utilizing national resources such as CAQH and NPPES.
  • Handle credentialing, linking, and revalidation of providers and groups with both commercial and government insurance payers.
  • Administer initial and recredentialing privileging applications for hospitals and surgery centers.
  • Maintain a comprehensive understanding of diverse provider credentialing and payer credentialing policies, including necessary procedures and forms.
  • Ensure the department is well-informed about enrollment requirements across various health plans and states.
  • Address and resolve unique challenges or delays in hospital privileging and payer enrollment processes, including issues related to claim denials.
  • Ensure the accuracy of the PAR list for all providers associated with contracted payers and distribute this list to relevant stakeholders as needed.
  • Respond to credentialing-related billing issues as indicated by the holding report.
  • Input provider demographic data and payer credentialing linking information into the credentialing software.
  • Complete EFT authorization documents to facilitate payment transactions between clients and carriers.
  • Exhibit a proven ability to collaborate effectively with various departments to drive positive outcomes.
  • Perform additional duties as assigned.
Qualifications:
  • Comprehensive understanding of provider enrollment structures and processes.
  • Exceptional organizational skills.
  • Strong written and verbal communication abilities.
  • Innovative and determined problem-solving skills.
  • Meticulous attention to detail and accuracy.
  • Client-focused approach, both internally and externally.
  • Commitment to maintaining strict confidentiality of sensitive information.
  • Ability to engage and communicate with individuals at all organizational levels.
  • Capacity to manage multiple tasks and prioritize effectively in a dynamic environment.
  • Ability to work collaboratively in a team setting.
  • Self-motivated with the capability to independently complete projects within set timelines.
  • Advanced proficiency in computer data entry, Microsoft Excel, and the ability to navigate various business-related software.
  • Proficient typing skills.
Education and Experience:
  • Certification as a Provider Credentialing Specialist (CPCS) is preferred.
  • A minimum of 3 years of experience in healthcare payer enrollment and credentialing/onboarding within a multi-specialty medical group, with government enrollment experience required.
  • Experience working with government agencies, including CMS and AHCA, is preferred.
Benefits:
  • Comprehensive company-paid medical, dental, and vision coverage.
  • Competitive salary.
  • Paid time off (PTO).
  • 401k plan with a 4% match.
  • Remote work stipend.
  • Company-paid short-term disability.
  • Life insurance coverage.
  • Pet insurance options.
Physical Demands/Environmental Factors:

This job description is not intended to encompass a complete list of duties or responsibilities required of the employee. Balance Health is proud to be an affirmative action employer and is committed to fostering an equal opportunity workplace, irrespective of race, color, religion, sex, sexual orientation, gender identity, ancestry, citizenship, national origin, marital status, veteran status, or disability. If you require accommodations due to a disability or special need, please inform us.
  • While performing the duties of this position, the employee is frequently required to stand or sit, use hands, and communicate verbally.
  • Specific vision capabilities required for this role include close vision, distance vision, and depth perception.
American with Disabilities Act (ADA) Specifications:

Qualified individuals with disabilities may request reasonable accommodations from the Director of Human Resources. Upon receiving an accommodation request, the Director will meet with the individual to discuss and identify the specific limitations resulting from the disability and explore potential accommodations that may assist in overcoming those limitations. The Director, in collaboration with a medical review and other appropriate management representatives, will determine the feasibility of the requested accommodation and its impact on business operations. The Director will inform the qualified individual of the decision regarding the accommodation request and the process for making the accommodation.

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