Credentialing Enrollment Specialist
Jersey City, NJ
Essential Job Functions:
- Thorough knowledge and proficiency in all aspects of provider enrollment in a professional healthcare practice setting.
- Understanding of credentialing processes as it relates to medical billing including Electronic Remittances, Service Locations and other details that could impact reimbursement.
- Primary source verification for resolves issues concerning provider's enrollment with insurance companies.
- Ensures timely completion of credentialing and re-credentialing of providers for all insurance carriers.
- Thorough knowledge and effectiveness in insurance portals including CAQH.
- Obtains appropriate credentials as well as updated copies prior to the expiration date of any license, certification, or other required document.
- Acts as liaison with Practitioners, billing management and insurance carriers.
- Maintains internal files including copies of current credentials and load/scan all documents into credentialing database.
- Maintain up to date and credentialing status in database. Generate routine reports in the database and sends to client.
- Assists in all areas of Managed Care contracting, reimbursement/billing, and human resources/talent acquisition.Required Qualifications:
- Bachelor Degree preferred or equivalent experience in business/healthcare environment.
- 3+ years of applicable experience in credentialing in a professional practice. Multi-specialty experience is a big plus.
- Excellent written and verbal communication skills with superior attention to detail.
- Ability to multi-task under tight timelines with strong administrative and exceptional organizational skills.
- Proficient in Microsoft Office Suite; Word, Excel, PowerPoint, Outlook calendaring and office scheduling and Internet navigation.
- Advanced knowledge of Microsoft Excel and knowledge of credentialing databases or reporting systems.