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Provider Enrollment and Credentialing Specialist
2 months ago
About Balance Health
At Balance Health, we are dedicated to enhancing the quality of life for individuals by promoting mobility and wellness. Our team comprises top-tier podiatrists, orthopedic surgeons, vascular surgeons, and physical therapists, all working collaboratively to provide outstanding patient care. This commitment has positioned us as a leader in the lower-extremity healthcare sector.
Position Summary:
Reporting to the Credentialing Manager, the Provider Enrollment and Credentialing Specialist plays a crucial role in managing the credentialing and enrollment processes. Key responsibilities include:
- Facilitating effective communication with the practice and implementation teams to gather essential credentialing and enrollment data.
- Overseeing the credentialing procedures for healthcare providers and the enrollment processes for various insurance payers.
Key Responsibilities:
- Manage the initial and re-credentialing applications for providers across payers, hospitals, and surgical centers.
- Conduct primary source verification utilizing national databases (e.g., CAQH, NPPES).
- Ensure proper credentialing, linking, and revalidation of providers and groups with both commercial and government insurance payers.
- Handle initial and recredentialing applications for hospital and surgical center privileges.
- Maintain up-to-date knowledge of credentialing policies and required documentation for various payers.
- Ensure the department is well-informed about enrollment requirements across different health plans and states.
- Address and resolve any issues or delays related to hospital privileging and payer enrollment processes.
- Maintain an accurate list of participating providers for contracted payers and disseminate this information as needed.
- Resolve any credentialing discrepancies as indicated by internal reports.
- Perform data entry for provider demographics and credentialing information in the designated software.
- Complete necessary EFT authorization forms to facilitate payment processes.
- Collaborate effectively with various departments to drive positive outcomes.
- Perform additional duties as assigned.
Qualifications:
- In-depth understanding of provider enrollment structures and processes.
- Exceptional organizational skills.
- Strong written and verbal communication abilities.
- Creative problem-solving skills with a focus on persistence.
- Meticulous attention to detail and accuracy.
- Client-focused approach, both internally and externally.
- Ability to maintain confidentiality regarding sensitive information.
- Strong interpersonal skills to interact 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 complete projects independently within set timelines.
- Proficient in data entry and experienced with Microsoft Excel and other relevant software.
- Strong 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 within a multi-specialty medical group is required.
- Experience working with government agencies such as CMS and AHCA is preferred.
Benefits:
- Comprehensive company-sponsored medical, dental, and vision coverage.
- Competitive salary package.
- Paid time off (PTO).
- 401k plan with a 4% employer match.
- Remote work stipend.
- Company-paid short-term disability coverage.
- Life insurance options.
- Pet insurance available.
Physical Demands and Work Environment:
This job description is intended to provide a general overview of the responsibilities and requirements of the position. Balance Health is an equal opportunity employer, committed to creating a diverse and inclusive workplace.
- Employees may be required to stand or sit for extended periods, use their hands, and communicate verbally.
- Specific vision abilities required include close vision, distance vision, and depth perception.
Americans with Disabilities Act (ADA) Compliance:
Qualified individuals with disabilities may request reasonable accommodations from the Director of Human Resources to assist in performing the essential functions of the job.
