Healthcare Credentialing and Enrollment Specialist
Nomi Health
This job is no longer accepting applications
See open jobs at Nomi Health.See open jobs similar to "Healthcare Credentialing and Enrollment Specialist" Peterson Ventures.Remote
Posted on Aug 24, 2024
We are seeking a detail oriented and experienced Healthcare Credentialing and Enrollment Specialist to join our team. You will play a crucial role in ensuring that our healthcare providers are credentialed and enrolled with various insurance plans, enabling seamless patient care and reimbursement processes
How you will make an impact
- Credentialing Process Management: Manage the credentialing process for healthcare providers, including physicians, nurse practitioners, and allied health professionals.
- Enrollment with Insurance Plans: Initiate and complete enrollment applications with various insurance plans and networks.
- Verification and Documentation: Verify provider credentials, licenses, certifications, and relevant documentation required for credentialing and enrollment.
- Managing Multiple Deadlines: Prioritize and manage multiple credentialing and enrollment deadlines effectively to ensure timely provider participation in insurance networks.
- Communication and Engagement: Foster positive relationships and effectively engage with healthcare providers to facilitate necessary credentialing and enrollment activities.
- Update Provider Profiles and Rosters: Maintain and update provider profiles and rosters with accurate information regarding credentials, affiliations, and insurance participation.
- Compliance: Ensure compliance with all regulatory requirements and standards related to credentialing and enrollment.
- Database Management: Maintain accurate and updated provider information in credentialing and enrollment databases.
- Problem Resolution: Address and resolve issues related to credentialing and enrollment, such as application denials or delays.
- Lead a team of credentialing specialists, train administrative assistants, and develop efficient workflows to ensure timely completion of multiple projects.
What we are looking for
- Bachelor’s degree in Healthcare Administration, Business Administration, or related field (or equivalent work experience).
- Experience: Minimum of 3 years of experience in healthcare credentialing and enrollment.
- Strong knowledge with credentialing standards, regulations, and procedures. Proficiency in using credentialing software and databases.
- Strong organizational skills with the ability to manage multiple deadlines and priorities. Excellent communication and interpersonal skills. Ability to engage and collaborate effectively with healthcare providers.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
- Experience working in a healthcare setting, such as a hospital, clinic, or healthcare management organization preferred.
- Familiarity with Medicare, Medicaid, and commercial insurance plans preferred.
- Expert knowledge navigating Medicaid state websites, provider enrollments and ID updates, and group enrollments preferred.
This job is no longer accepting applications
See open jobs at Nomi Health.See open jobs similar to "Healthcare Credentialing and Enrollment Specialist" Peterson Ventures.