Credentialing Enrollment Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct primary source verifications of documentation necessary for the credentialing and re-credentialing of MGD providers in managed care.

• Offer resolution and support for billing issues related to provider enrollment and credentialing.

• Input provider information into the ECHO database following departmental guidelines.

• Provide updates to System entities regarding the status of applicants.

• Monitor expired licenses, board certifications, insurance, and DEA registrations.

• Prepare physician documentation for audits conducted by managed care organizations, Corporate Compliance, and accreditation entities.

• Perform practice site visits for MGD practices.

• Ensure timely and accurate communication of information to Managed Care Organizations and the System.

• Review provider directories and other materials generated by managed care organizations.

• Assist the CPN Credentialing and Quality Review Committee.

• Interact with employees, corporate staff, providers, and external agencies.

• Occasionally travel to other corporate locations.

⛳️ Requirements

• High school diploma or GED is mandatory.

• Bachelor's degree is preferred.

• Minimum of three years experience in provider credentialing, privileging, and/or enrollment within a hospital, managed care plan, or CMS setting.

• Proficient in the use of personal computers, Windows, and Microsoft applications.

• Familiarity with copier and fax machines, as well as multi-line telephones.

• Skills in typing, word processing, and business correspondence are essential.

• CPCS or CPMSM certification is preferred.

• Regular verbal and written communication in English is required.

• Availability to work Monday through Friday, from 8:00 AM to 4:30 PM.

• Capability to sit for extended periods, stand, walk, use repetitive wrist/arm motions, and lift between 20–50 pounds.

• Ability to function under time constraints, manage heavy workloads, and handle frequent interruptions.

• Occasional travel to other corporate offices is expected.

• Personal vehicle is required.

• Adequate vision and hearing abilities are necessary.

🏝️ Benefits

• Eligible for benefits.

• Premium compensation such as shift differentials, on-call pay, and more based on a teammate's schedule.

• Incentive pay available for specific positions.

• Opportunity for annual salary increases based on performance evaluations.

• Paid Time Off (PTO) programs.

• Comprehensive medical, dental, vision, life, and Short- and Long-Term Disability benefits.

• Flexible Spending Accounts for qualifying healthcare and dependent care expenses.

• Adoption assistance and paid parental leave programs.

• Defined contribution retirement plans with employer matching.

• Additional financial wellness initiatives.

• Educational Assistance Program available.

• Career development opportunities.

• Well-being programs offered.