EHR Credentialing & Enrollment Specialist

HealthRIGHT 360; Los Angeles (CA); Hybrid; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Union-eligible

Zusammenfassung

HealthRIGHT 360 is seeking an EHR Billing Credentialing Analyst to coordinate provider credentialing, enrollment, and data maintenance within our EHR system in California. The role requires close collaboration with clinical leadership, HR, Compliance, Billing, and external agencies to ensure compliant credentials and timely enrollments.

The position supports onboarding, data validation, and system integrations related to credentialing workflows, helping the agency deliver uninterrupted services

Qualifikationen

• Minimum 3 years’ experience in healthcare credentialing, provider enrollment, EHR systems, or healthcare administration.
• Experience with provider credentialing and payer enrollment processes.
• Knowledge of HIPAA and CFR 42 CFR Part 2; familiarity with Medi-Cal and county behavioral health systems preferred.

Aufgaben

• Maintain and organize provider credentialing records, licenses, certifications, DEA registrations, NPIs, and payer enrollment documentation in the EHR system.
• Coordinate initial credentialing, recredentialing, and provider enrollment with payers, counties, and regulatory agencies.
• Configure and maintain provider profiles, specialties, service locations, supervising relationships, and credentialing data in the EHR system.
• Monitor credential expiration dates and ensure timely renewals to maintain compliance and billing readiness.
• Prepare and submit enrollment applications and supporting documentation for provider participation with counties and managed care plans.
• Conduct regular audits of provider data and credentialing records for accuracy and compliance.
• Investigate credentialing discrepancies, missing documentation, enrollment delays, and provider setup issues.

Kenntnisse

Credentialing

Enrollment management

EHR systems

Compliance

Attention to detail

Ausbildung

Bachelor's degree

Master’s degree

Tools

EHR system

Jobbeschreibung

JOB SUMMARY

HealthRIGHT 360, a family of programs, operates in 11 counties throughout California. Offering a comprehensive range of medical and behavioral health services, HealthRIGHT 360 serves marginalized communities, including primary care, mental health support, detoxification, residential and outpatient substance use disorder treatment, and transitional services tailored to individuals involved in the criminal justice system.

The Electronic Health Records (EHR) department is integral to our operations, ensuring that all electronic health record systems function optimally and that all users receive the necessary training and support. As a fast-paced, service-oriented department, we aim to empower all programs in delivering the best possible client services.

The EHR Billing Credentialing Analyst is responsible for coordinating, maintaining, and monitoring provider credentialing and enrollment processes within the electronic health record (EHR) system and associated payer platforms. This position works closely with clinical leadership, Human Resources, Compliance, Billing, and external agencies to ensure providers maintain active and compliant credentials, licenses, certifications, and payer enrollments required for service delivery and reimbursement.

This role includes maintaining provider records, tracking credentialing deadlines, supporting onboarding and recredentialing processes, validating provider data accuracy within EHR systems, troubleshooting credentialing-related system issues, and ensuring compliance with county, state, federal, and payer requirements. The EHR Billing Credentialing Analyst will also assist with implementations related to provider setup, workflows, and system integrations associated with credentialing and enrollment processes.

KEY RESPONSIBILITIES

Credentialing & Enrollment:

• Provider Credentialing Maintenance: Maintain and organize provider credentialing records, licenses, certifications, DEA registrations, NPIs, and payer enrollment documentation within the EHR system.
• Credentialing & Recredentialing Coordination: Coordinate initial credentialing, recredentialing, and provider enrollment processes with payers, counties, and regulatory agencies.
• Provider Data Configuration: Configure and maintain provider profiles, specialties, service locations, supervising relationships, and credentialing-related information in the EHR system.
• Credential Monitoring: Monitor credential expiration dates and ensure timely renewals to maintain provider compliance and uninterrupted billing capabilities.
• Payer Enrollment Support: Prepare and submit enrollment applications and supporting documentation for provider participation with counties, managed care plans, and other funding entities.
• Data Validation & Auditing: Conduct regular audits of provider data and credentialing records to ensure accuracy, completeness, and compliance.
• Issue Resolution: Investigate and resolve credentialing discrepancies, missing documentation, enrollment delays, and provider setup issues.
• Help Desk Escalation Support: Serve as an escalation resource for credentialing-related EHR support requests and technical issues.
• Communication & Collaboration: Communicate and collaborate with EHR, Compliance, HR, Billing, Fiscal, and Clinical teams as well as the Counties to ensure provider records remain accurate and compliant.
• Meetings: Attend and participate in department, inter-team, and agency meetings as appropriate.
• Miscellaneous: Other duties as assigned.

Process:

• Workflow Improvement: Utilize problem-solving skills to improve credentialing workflows, tracking systems, and provider onboarding processes.
• Implementations: Assist EHR leadership with credentialing-related implementations, provider onboarding workflows, and system enhancements for new programs or funding streams.

Intangibles:

• Relationships: Develop and maintain effective working relationships with clinical leadership, HR, compliance teams, and external credentialing entities.
• Agency Philosophy and Mission: Incorporate agency philosophy and mission in all aspects of job performance.
• Confidentiality: Maintain confidentiality regarding clients, providers, employees, and operations of the agency in accordance with HIPAA and 42 CFR Part 2.
• Judgment: Exercise good judgment in the performance of duties and responsibilities.

And other duties as assigned.

QUALIFICATIONS

Education, Experience, or Certification

Required:

• Minimum of 3 years’ experience working in healthcare credentialing, provider enrollment, EHR systems, or healthcare administration
  OR
• Master’s degree or higher.

Desired:

• Experience with provider credentialing and payer enrollment processes.
• Experience maintaining provider data within EHR systems and/or county systems.
• Experience with compliance tracking, audits, and documentation management.
• Experience with Help Desk or user support preferred.
• Knowledge of HIPAA and CFR 42.
• Familiarity with Medi-Cal, county behavioral health systems, and payer credentialing requirements preferred.

Knowledge and Skills

• High degree of accuracy, speed, and attention to detail.
• Ability to multitask on projects and daily tasks while maintaining effective communication.
• Ability to successfully prioritize.
• Ability to work efficiently and productively in an independent manner.
• Excellent verbal, written, and interpersonal skills.
• Integrity to handle sensitive information in a confidential manner.
• Strong organizational and documentation management skills.
• Desire to learn and eagerness to elevate the efficiency of the department and agency.

Competencies

• Provider Credentialing & Enrollment Management –Coordinating and maintaining provider credentialing, payer enrollment, and recredentialing processes in compliance with regulatory and payer requirements.
• EHR Provider Configuration & Maintenance – Ability to configure and maintain provider records, specialties, licenses, and credentialing-related information within the EHR system.
• Credential Monitoring & Compliance – Proficiency in monitoring expiration dates, renewals, and compliance requirements to ensure uninterrupted provider eligibility and billing readiness.
• Documentation Review & Audit Readiness – Ability to organize, review, and audit provider documentation to ensure accuracy, completeness, and compliance with agency and payer standards.
• Issue Resolution & Problem-Solving – Strong analytical and problem-solving skills to investigate credentialing discrepancies, resolve enrollment issues, and improve workflow processes.
• Help Desk Support & Escalation – Provide advanced support for credentialing-related EHR issues and assist users with troubleshooting and system navigation.
• Cross-Department Communication & Collaboration – Effective communication and collaboration with EHR, HR, Compliance, Billing, Fiscal, and Clinical teams to support provider onboarding and maintenance.
• Workflow Improvement & Process Optimization – Ability to identify inefficiencies and implement improvements to credentialing tracking systems and operational workflows.
• Confidentiality & Compliance – Commitment to maintaining confidentiality regarding provider, client, and operational information in accordance with HIPAA and CFR 42 guidelines.

Background Check and Other Requirements

• Capable of obtaining and maintaining a satisfactory background check.
• Applicants must not be on parole or probation due to funding regulations. Qualified candidates with a criminal record will be considered for employment.
• Capable of meeting credential requirements, if applicable.
• Capable of meeting program requirements.