Description
The Provider Enrollment and Credentialing Specialist is responsible for obtaining all provider required credentialing information from the newly hired Nurse Practitioners & Physician Assistants. Responsible for submitting this information to the required organizations for credentialing with governmental agencies & private payers as well as tracking and facilitating this process.
Requisition Type
General Recruiting
Job Schedule
Full time
Responsibilities
Obtain & submit the required information to enroll & accelerate credentialing of healthcare providers.
Responsible for completing Medicare application for 855I, 855R and 855B and other payer applications.
Responsible for setting up new Groups from the onset.
Maintain information on an annual basis for RN, ARNP or PA licenses, national certification, collaborative agreements, provider numbers, CPR certification, PPD annual tests and other clinical related requirements.
Track credentialing status with each carrier to assist with staffing needs.
Maintains database for all in-house training sessions and provides required information to Human Resources.
Establish & maintain a strong working relationship with NPs, private insurers, nursing & medical boards.
Track the status of provider credentialing on a continuous basis, providing additional information & innovative solutions.
Performs other duties as assigned.
Qualifications
One year of direct experience completing Medicare 855I, 855R, and 855B applications, & other payer applications, is required. Experience setting up new Groups from the onset & experience in a hospital credentialing or provider enrollment department, is desirable.
Payer credentialing process knowledge at a high level is required and prior experience with CLIA applications.
CPCS (Certified Provider Credentialing Specialist) preferred.
Must be familiar with national data base for credentialing and an understanding of the business model impact on enrollment in various states is desirable.
Strong computer skills with intermediate knowledge of Word, Excel, Access and Power Point and internet experience. 
Excellent telephone skills, customer service skills, strong organizational skills needed with attention to detail and be accustomed to follow up on work pending.
Team orientation & flexibility in accepting change.
Professional appearance and demeanor.