Provider 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

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.