Credentialing and Enrollment Specialist

Emergency Staffing Solutions, Inc.; Dallas (TX); Vor Ort; USD 50.000 - 65.000; Vollzeit

Zusammenfassung

Emergency Staffing Solutions, Inc. is seeking a Provider Credentialing and Enrollment Specialist to drive accurate credentialing with client hospitals and enrollment with payers, including CMS programs.

You will support onboarding, maintain provider files, and ensure regulatory compliance in a collaborative healthcare administration team. The role emphasizes end-to-end credentialing, payer enrollment, and staying current with NCQA/JCAHO standards to guarantee compliant credentialing activities

Qualifikationen

• Experience in managed care environments or healthcare administrative roles involving credentialing or enrollment processes.
• Knowledge of health insurance policies, state healthcare regulations, and NCQA/JCAHO considerations.
• Proficiency with Microsoft Office Suite and credentialing software platforms.
• Familiarity with medical terminology, databases, and healthcare compliance protocols.
• Experience reviewing credentialing applications and managing provider files in regulated settings.

Aufgaben

• Manage end-to-end provider credentialing including review, verification, and file maintenance.
• Enroll providers with health payers and government programs to ensure reimbursement workflows.
• Stay updated on state regulations and accreditation standards to ensure compliance.
• Use credentialing software to track applications, update databases, and generate reports.
• Coordinate with providers to gather documentation while maintaining confidentiality and HIPAA compliance.
• Collaborate with contract management to align provider agreements with credentialing status.

Kenntnisse

Credentialing

Enrollment

HIPAA compliance

Regulatory knowledge

Organizational skills

Tools

Microsoft Office

Credentialing software

Healthcare software

Jobbeschreibung

Join our dynamic healthcare team as a Provider Credentialing and Enrollment Specialist! In this vital role, you will be the cornerstone of ensuring our healthcare providers are accurately credentialed with client hospitals and enrolled with various payers, including government programs like Medicare and Medicaid. Your expertise will help streamline provider onboarding processes, maintain compliance with healthcare regulations, and support the delivery of high-quality patient care. This position offers an exciting opportunity to work within a collaborative environment dedicated to excellence in healthcare administration.

Duties

• Manage the end-to-end provider credentialing process, including application review, verification of credentials, and ongoing maintenance of provider files.
• Enroll new providers with health insurance payers, government agencies such as CMS (Centers for Medicare and Medicaid Services), and other relevant entities to ensure seamless reimbursement workflows.
• Maintain up-to‑date knowledge of state healthcare regulations, accreditation standards (such as JCAHO), NCQA standards, and CMS regulatory compliance requirements to ensure all credentialing activities meet legal and industry standards.
• Utilize healthcare software applications and medical credentialing software to track application statuses, update databases, and generate reports for internal review.
• Review medical credentialing applications thoroughly, verifying credentials against licensing boards, professional references, and regulatory bodies.
• Coordinate with providers to gather necessary documentation while handling confidential information with the utmost discretion and compliance.
• Collaborate with contract management teams to ensure provider agreements align with credentialing status and regulatory requirements.
• Monitor payer enrollment statuses regularly, troubleshoot issues promptly, and communicate effectively with insurance companies to resolve discrepancies or delays.

Qualifications

• Proven experience in managed care environments or healthcare administrative roles involving provider credentialing or enrollment processes.
• Strong knowledge of health insurance policies, health regulation policies, state healthcare regulations, and accreditation standards such as NCQA and JCAHO.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) along with experience using healthcare software applications and medical credentialing software platforms.
• Familiarity with medical terminology, database management systems, and healthcare compliance protocols is essential.
• Prior experience reviewing medical credentialing applications and managing provider files within a regulated environment is highly desirable.
• Excellent organizational skills with keen attention to detail to ensure accuracy in credentialing documentation and payer enrollment activities.
• Ability to handle confidential information responsibly while maintaining compliance with HIPAA (Health Insurance Portability and Accountability Act) standards.
• Contract management experience in healthcare settings is a plus; familiarity with CMS regulations related to provider enrollment is preferred.

Embark on a rewarding career path where your expertise directly impacts patient access to quality care! We are committed to fostering an inclusive environment that values your skills and dedication as we work together to uphold the highest standards of healthcare administration.