Credentialing and Enrollment Specialist

Job Purpose: Oversees and is responsible for the critical role of credentialing and recredentialing all medical providers who provide care at Avance Care. Responsible for ensuring providers are credentialed and enrollment maintaining up to date data for each provider in online systems; ensure timely renewal of licenses and certifications.

Essential Duties and Responsibilities

• Oversees and ensures all providers are accurately and quickly credentialed and recredentialed with appropriate entities
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
• Ensures practice addresses are current with health plans, agencies, and other entities
• Maintains information in Credentialing folder
• Audits health plan directories for current and accurate provider information
• Updates each provider’s CAQH database file timely according to the schedule published by CMS
• Maintains accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Maintains continuous knowledge of current health plan and agency requirements for credentialing providers
• Tracks license and certification expirations for all providers to ensure timely renewals including DEA and professional liability
• Prioritizes work appropriately to prepare for high volume needs
• Participates in relevant meetings and shares information of credentialing status with departments
• Work closely with the Revenue Cycle teams to identify and resolve any denials or authorization issues related to provider credentialing
• Accomplishes all tasks as assigned or become necessary

Qualifications

Experience, Education and Licensure:

• Minimal education level for this type of role would be consistent with a Associate’s Degree, or equivalent experience.
• Two year medical business experience, preferred
• Experience in healthcare
• Basic understanding of National Committee for Quality Assurance (NCQA) Credentials Verification Organization services, preferred

Knowledge, Skills, and Abilities:

• Ability to read and interpret documents such as professional journals, safety rules, operating and maintenance instructions, procedure manuals, and government regulations
• Ability to write reports, business correspondence, and procedure manuals
• Ability to effectively present information and respond to questions from managers, employees, clients, customers, and the general public
• Ability to interact and communicate with a variety of people, both on a one-on-one basis and in meetings and group presentations
• Ability to relate to and work with ill, emotionally upset, and sometimes hostile people
• Ability to anticipate and react calmly to emergency situations
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to follow direction
• Ability to think logically in order to troubleshoot, analyze situations, and make appropriate decisions
• Proficient computer skills, including working knowledge of Microsoft Office Suite, e-mail systems, and web-based programs
• Ability to handle multiple tasks simultaneously
• Knowledge and understanding of how for-profit medical practices run
• Knowledge and understanding of medical billing and coding

Job Type: Full-time

Pay: From $40,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Durham, NC 27707

Salary : $40,000 - $-1