Credentialing Coordinator: Enrollments & Compliance

Mbms Llc; Spring Ridge (PA); On-site; USD 42,000 - 64,000; Full time

Job summary

Mbms Llc in Reading, PA is seeking an Experienced Credentialing Specialist to support provider enrollment and credentialing workflows. You will maintain licensure, certifications, and enrollment documents while coordinating with CS and other departments.

Responsibilities include processing enrollments, conducting primary source verification, maintaining credentialing software, and ensuring accuracy of provider records.

Qualifications

• High School diploma or equivalent.
• CPMSM or Certified Provider Credential Specialist certificate preferred or minimum two years’ experience.
• Above average knowledge of basic medical billing and insurance carriers.
• Demonstrated written and oral communications skills.
• Proficient with Microsoft Excel.
• Ability to analyze, interpret and draw inferences from research findings and prepare reports, documentation generation.
• Ability to manage confidential information.

Responsibilities

• Maintains confidentiality of provider information.
• Assists in department training and client onboarding for MBMS.
• Completes provider payer enrollment and re-credentialing/revalidation applications.
• Monitors provider/organization payer enrollment applications and follows-up as required.
• Maintains primary source verification of all providers current Medical Licenses, DEA’s, and board certifications.
• Maintains copies of Physician Group current licenses, ACR Certification and all required documentation for enrollment purposes.
• Maintains copies of the providers current malpractice insurance and all educational documentation.
• Maintains provider contract files by requesting contracts and working with clients to ensure they agree to all terms and conditions.
• Maintains Tickets in the Credentialing Department Ticketing System.
• Collaborate with internal departments, such as CS (Client Service) to ensure seamless integration and coordination of provider enrollment activities and billing.
• Maintaining credential stream software with provider demographics and all assigned physician groups.
• Processing Enrollments and utilizing workflows via Credential Stream for provider enrollment.

Skills

Excel

Written communication

Oral communication

Data analysis

Confidential information handling

Education

High School diploma

CPMSM certificate

Job description

Mbms Llc in Reading, PA is seeking an Experienced Credentialing Specialist to support provider enrollment and credentialing workflows. You will maintain licensure, certifications, and enrollment documents while coordinating with CS and other departments.

Responsibilities include processing enrollments, conducting primary source verification, maintaining credentialing software, and ensuring accuracy of provider records.