Provider Credentialing & Enrollment Specialist

MBMS; Reading, Wyomissing (Berks County, Berks County); On-site; USD 42,000 - 54,000; Full time

Job summary

MBMS in Reading, PA is seeking an Experienced Credentialing Specialist to support provider enrollment and credentialing processes. You will maintain confidentiality, assist in onboarding, and complete payer enrollment/re-credentialing applications.

You will monitor enrollment activities, verify licenses and certifications, maintain documentation for enrollment, and manage provider contracts. Collaboration with CS and other departments is essential for seamless operations.

Qualifications

• Requires 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.

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 licenses, DEA’s, and board certifications.
• Maintains copies of physician group licenses, ACR certification and enrollment documentation.
• Maintains copies of malpractice insurance and educational documentation.
• Maintains provider contract files and coordinates with clients on terms.
• Maintains tickets in Credentialing Department Ticketing System.
• Collaborates with internal departments to ensure seamless enrollment and billing coordination.
• Maintains credential stream software with provider demographics and assigned physician groups.
• Processes enrollments and uses Credential Stream workflows for provider enrollment.

Skills

Provider enrollment

Credentialing workflow

MS Excel

Communication skills

Education

CPMSM or Certified Provider Credential Specialist (CCPS) certificate

Tools

Credential Stream

Microsoft Excel

Job description

MBMS in Reading, PA is seeking an Experienced Credentialing Specialist to support provider enrollment and credentialing processes. You will maintain confidentiality, assist in onboarding, and complete payer enrollment/re-credentialing applications.

You will monitor enrollment activities, verify licenses and certifications, maintain documentation for enrollment, and manage provider contracts. Collaboration with CS and other departments is essential for seamless operations.