Credentialing Specialist - Full Time

Sandusky, OH

The Credentialing Enrollment Specialist administers new provider enrollment and credentialing applications process. The Credentialing Enrollment Specialist is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. In this role, you will ensure the set up of the clients for electronic claims submission and electronic remittance advice. You will follow up on the status of applications for physicians and payers, and track the progress on all pending applications.

Duties And Responsibilities:

  • Enrolls new providers and groups with contracted payers.
  • Follow up with payers to ensure timely application processing/provider enrollment
  • Enroll/Revalidate DMERC license by location
  • Maintains database of provider IDs, NPPES logins, and CAQH logins.
  • Creates and maintains CAQH profile and ensures contracted payers receive updated information.
  • Revalidates providers and groups with contracted payers.
  • Maintains knowledge of current payer requirements/request.
  • Assist billing with issues that pertain to provider enrollment denials/issues.
  • Audits payer directories for current and accurate provider/location information.
  • Perform other reasonably related duties assigned by the immediate supervisor or other management personnel.

Competencies:

  • Previous experience working with files or the collection and coordination of data
  • Proficient in the use of Excel.
  • Experience with general computer software.
  • Ability to learn new software programs quickly.
  • Excellent customer service skills.
  • Excellent verbal and written communication skills.
  • Professional and effective interaction skills with co-workers, clients, providers, and vendors.
  • Proven ability to work well individually and as a team member.
  • Ability to prioritize and organize multiple tasks.
  • Ability to remain organized with multiple interruptions.
  • Ability to make independent decisions.
  • Strong attention to detail.
  • Strong business acumen.
  • Ability to adapt to constantly changing environment.

Education and Work Experience:

  • High School graduate or GED; Associates degree preferred
  • 1-2 years experience in business and/healthcare environment

Environmental/Working Conditions:

  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. Minimal exposure to communicable diseases.

Physical/Mental Demands:

  • Work is typically performed at a desk or table requiring the use of standard office equipment. Intermittent sitting, standing and stooping.

Equal Employment Opportunity Employer