Credentialing Associate: Provider Enrollment & Audits

highmarkhealth; New Jersey; Hybrid; USD 27,000 - 38,000; Full time

Job summary

Highmark Health is seeking a credentialing specialist to process provider applications and re-applications, maintain the provider database, and communicate with providers regarding status by phone and mail. The role involves credentialing, re-credentialing, verifications, and supporting projects to streamline functions.

Responsibilities include handling enrollment paperwork, ensuring completeness, and training team members as needed.

Qualifications

• High School Diploma or GED required.
• 0-1 years of experience.
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft Office experience (Word, Excel, PowerPoint).

Responsibilities

• Credential and re-credential providers.
• Contact providers or representatives by phone or in writing to obtain additional information while processing enrollment applications.
• Screen applications and paperwork for completeness and accuracy; send to credentialing vendor when needed.
• Perform credentialing verifications and load provider into networks and provider database.
• Manage credentialing inventory, reports and projects to meet deadlines.
• Train credentialing team on systems, software, processes and procedures (as applicable).
• Create and distribute monthly reports and handle complex credentialing issues.
• Support audits, business partners, internal departments and external clients.

Skills

Provider data management

Customer service

Claims processing

Microsoft Office

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File

Customer Service inquiry system

Job description

Highmark Health is seeking a credentialing specialist to process provider applications and re-applications, maintain the provider database, and communicate with providers regarding status by phone and mail. The role involves credentialing, re-credentialing, verifications, and supporting projects to streamline functions.

Responsibilities include handling enrollment paperwork, ensuring completeness, and training team members as needed.