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Provider Enrollment Specialist

2 months ago

Columbus, Ohio, United States MEDIC MANAGEMENT GROUP LLC Full time
Job Summary

We are seeking a highly skilled Provider Enrollment/Credentialing Specialist to join our team at MEDIC MANAGEMENT GROUP LLC. This role will be responsible for credentialing new and established healthcare providers, as well as maintaining accurate and up-to-date information.

Key Responsibilities
  • Collect, update, and maintain necessary provider information and documentation, verifying accuracy whenever possible.
  • Establish and maintain data entry in CAQH, ensuring timely and complete applications.
  • Prepare credentialing applications for initial applications and reappointments, adhering to department policies and procedures.
  • Verify provider and group information with insurance companies, including addresses, provider rosters, contracted plans, and provider numbers.
  • Coordinate enrollment and termination processes for all providers, maintaining good rapport with Health Plan Representatives.
  • Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states, building strong working relationships with medical facilities and provider offices.
  • Enter, update, and maintain NPI and other applicable provider numbers, providing concise and timely communication to leadership regarding potential credentialing issues.
  • Proactively share knowledge with colleagues, performing analysis and follow-up on initial applications and reappointments.
  • Work with physicians, professional staff, and physicians' office staff to acquire necessary materials and information.
Requirements
  • High school diploma or equivalent.
  • Minimum 3 years of credentialing experience.
  • Billing knowledge and experience preferred.
  • Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances.
  • Proficiency in MS Office, primarily Word, Outlook, and Excel.
  • Excellent interpersonal skills to communicate with medical staff, providers, and clients.
  • Detail orientation.
  • Ability to abide by HIPAA standards and requirements.
  • Ability to multi-task.
  • Ability to work as a team player.
  • Ability to handle confidential information in a professional manner.
  • Willingness to take on new tasks and responsibilities.
  • Capable of taking the initiative to accomplish tasks.
  • Strong time management and organization skills.
  • Excellent problem-solving and decision-making abilities.
Physical Demands

The work may require sitting for long periods of time, operating a computer, keyboard, telephone, fax, or other office equipment through a normal business day. Vision must be correctable to 20/20 for viewing information on a computer screen and reading information in a paper format. Hearing must be in the normal range for telephone contacts.