Credentialing Enrollment Specialist

Advocate Health; Charlotte (NC); On-site; USD 33,000 - 49,000; Full time

Benefits offered by this job

Paid Time Off

Health benefits

Dental benefits

Vision benefits

Life insurance

Short- and Long-Term Disability

Flexible Spending Accounts

Adoption assistance

Parental leave

Retirement plan with employer match

Educational Assistance

Job summary

Advocate Health is seeking a Credentialing Specialist to oversee internal processes and regulatory requirements for provider applications and enrollment. You will assist in planning, development, and organization within the department.

The role includes primary source verifications, data entry in the ECHO database, and ensuring timely receipt of necessary documentation. You will support audits and communicate with MCOs and corporate compliance teams.

Qualifications

• High school diploma or GED required; Bachelor's degree preferred.
• Three years' experience in provider credentialing, privileging, and/or enrollment in hospital, managed care plan or CMS environment.
• NAMSS CPCS or CPMSM certification preferred.

Responsibilities

• Performs primary source verifications for credentialing and re-credentialing of providers.
• Resolves billing issues related to provider enrollment and credentialing.
• Enters provider data in the ECHO database according to established processes.
• Follows up on documentation like licenses, certifications, insurance, and DEA registrations.
• Prepares physician files for audits by managed care organizations and accreditation entities.
• Conducts practice site visits and facilitates communication with MCOs and the System.
• Reviews provider directories and demographics for accuracy.
• Provides team support to Credentialing and Quality Review Committee.

Skills

Provider credentialing

Enrollment processes

Data entry

Interpersonal communication

Education

High school diploma or GED

Bachelor's degree preferred

NAMSS CPCS/CPMSM certification preferred

Tools

ECHO database

Job description

Job Summary

Oversees the internal processes and procedures as well as Governmental, and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning, development, and organization.

Essential Functions

• Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
• Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
• Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
• Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
• Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.
• Conducts practice site visits for practices within MGD. Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
• Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation.
• Provides Team member support to the CPN Credentialing and Quality Review Committee.

Physical Requirements

Perform most duties under normal office conditions which may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles 20-50 pounds. Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone or other employees. Must use frequent and variable body movements during filing and maintaining records. Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies. Require occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.

Education, Experience and Certifications

High school diploma or GED required; Bachelor's degree preferred. Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is required. Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone required. Experience in typing, word processing, and business correspondence is required. Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

Annual Base Pay: $23.65-$35.50

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

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