Job PURPOSE

The Credentialing & Enrollment Specialist supports credentialing and enrollment processes to ensure all Relias Healthcare providers are enrolled with insurance payers timely and efficiently. This role has high impact on revenue cycle and positive provider and payer relationships

Duties and Responsibilities

Under general supervision, the Credentialing & Enrollment Specialist is responsible for collecting, documenting, and retaining provider records that are necessary in the enrollment and credentialing process. This role requires excellent organization and communication skills to interact with leadership, providers, and payers. The Credentialing & Enrollment Specialist will assist with provider enrollments using time sensitive documentation, electronic processes, and tools in a fast-paced, high-volume environment.

• Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire
• Supports Site Coordinators to answer inquiries and provides enrollment and credentialing updates
• Maintains accurate provider records and makes edits to Modio profiles. Enters new providers and updates data, as needed
• Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates
• Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities
• Works closely with the Enrollment Specialist to stay apprised of provider candidates’ statuses and alignment of tasks/goals as a team
• Serves as subject-matter-expert for providers with onboarding instructions and support
• Proficient use of Modio and Relias’ Systems
• Demonstrates proficiency in the use of databases, CAQH, NPPES, Licensing Boards, and payer Web sites that will be used daily
• Verifies data for accuracy and completeness
• Works collaboratively with team members to address new issues as they arise and responds promptly with acknowledgement or status
• Enters provider applications into payer portals for enrollment
• Responds to insurance payers’ requests for information in a prompt and professional manner
• Works as a team with outside vendors and facilities who share the goal of enrolling our providers
• Maintains confidentiality with providers’ personal information and upholds respect for privacy and regulatory requirements
• Provides excellent customer service
• Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility and alerts leadership to any potential risk regarding meeting deadlines, set standards or goals in place
• All other duties as assigned

Qualifications

• High school graduate or equivalent required
• Minimum two (2) years’ experience in a medical business office setting supporting administration; must have some credentialing experience.
• Experience working with insurance enrollments, strongly preferred.
• Intermediate proficiency level in Excel
• High level of attention to detail with the ability to problem solve and function independently
• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
• Strong verbal and written communication skills

Work Locations

The Credentialing & Enrollment Specialist will work remotely with some travel to the corporate office

N/A