Credentialing Specialist (Remote)

Socket.dev; United States; Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off

401(k) with company match

Referral Program

Payactiv

Job summary

Ennoble Care is seeking a Full-Time Credentialing Specialist to manage provider enrollment applications and related link letters across multiple payer networks. You will coordinate with providers and internal teams to ensure enrollment accuracy, timely revalidations, CAQH maintenance, and issue resolution to protect revenue.

The role requires 3+ years in provider enrollment, strong regulatory knowledge, and proficiency with Microsoft Office and Modio Health.

Qualifications

• Minimum 3 years’ experience in provider enrollment.
• Knowledge of government and commercial payer enrollment processes.
• Proficient in Microsoft Office applications.
• Preferred experience with Modio Health.
• Detail oriented, organized and able to multitask.
• Strong interpersonal and organizational skills with excellent customer service.
• Able to work in a fast-paced, acquisitional environment.
• Represents the organization in a positive and professional manner.

Responsibilities

• Prepare new and existing provider enrollment applications and/or written link letters.
• Create and submit new group enrollment applications when contracts are executed.
• Follow up timely with payers on submitted applications/letters for approval notices.
• Ensure timely revalidation of all providers and groups.
• Communicate with providers and other team members to resolve payer issues and confirm participating status.
• Manage all documentation in an organized manner and update Modio.
• Track all provider licensure and communicate with provider prior to expiration.
• Complete, update and maintain CAQH profiles for providers.
• Identify and communicate any potential enrollment issues that could result in loss of revenue.
• Establish relationships and maintain communication with provider representatives.
• Set up provider portals and maintain access for team members as needed.
• Participate in team meetings and communications.
• Perform specific assignments as directed by the Revenue Cycle Director.

Skills

Regulatory knowledge

payer enrollment knowledge

Provider enrollment experience

Detail oriented

Multitasking

Interpersonal skills

Organizational skills

Customer service

Fast-paced environment

Professionalism

Enrollment teamwork

Tools

Modio Health

Microsoft Office

Job description

About Us

Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care’s clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, “To Care is an Honor.” Join Ennoble Care today!

Job Description:

The Full-Time Credentialing Specialist is responsible for the timely execution of all group applications and provider applications/link letters. Serving as the point of contact for the organization’s credentialing application process, the Credentialing Specialist will communicate with providers and all teams to ensure accurate and up-to-date information regarding provider’s enrollment status.

Responsibilities:

• Prepare new and existing provider enrollment applications and/or written link letters
• Create and submit new group enrollment applications when contracts are executed
• Follow up timely with payers on submitted applications/letters for approval notices
• Ensure timely revalidation of all providers and groups
• Communicate with providers and other team members to resolve payer issues and confirm participating status
• Manage all documentation in an organized manner – upload documentation to a shared drive and update Modio
• Track all provider licensure and communicate with provider prior to expiration
• Complete, update and maintain CAQH profiles for providers
• Identify and communicate any potential enrollment issues that could result in loss of revenue
• Establish relationships and maintain communication with provider representatives
• Set up provider portals and maintain access for team members as needed
• Participate in team meetings and communications
• Perform specific assignments as directed by the Revenue Cycle Director

Qualifications:

• Maintain regulatory requirements, including all federal, state, local regulations and accrediting organization standards
• Knowledge of government and commercial payer’s enrollment processes and requirements
• Minimum 3 years’ experience in provider enrollment
• Preferred experience with Modio Health
• Detail oriented, organized and able to multitask
• Strong interpersonal and organizational skills
• Excellent customer service skills
• Able to work in a fast-paced, acquisitional environment
• Represent the organization in a positive and professional manner
• Demonstrated knowledge and experience working with the provider enrollment
• Comply with all organizational policies regarding ethical business practices
• Proficient in all Microsoft Office applications

Full-time employees qualify for the following benefits:

• Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.
• Paid Time Off
• Paid Office Holidays

All employees qualify for these benefits:

• Paid Sick Time
• 401(k) with up to 3% company match
• Referral Program
• Payactiv: pay-on-demand. Cash out earned money when and where you need it!

Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.

Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.