Provider Enrollment/Credentialing Specialist

Omega Healthcare Management Services Pvt. Ltd.; Boca Raton (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Omega Healthcare Management Services seeks a Credentialing Specialist to review and resolve enrollment tasks, generate enrollment data for the Credentialing Team, and monitor provider enrollment status. The role emphasizes effective communication with specialists and timely resolution of discrepancies while upholding HIPAA and security requirements.

The candidate should have 3–5 years of experience in insurance follow up and credentialing, with an Associate’s degree or equivalent; healthcare

Qualifications

• Minimum of 3-5 years prior experience in insurance follow up and/or credentialing and enrollment.
• Proven experience in customer service or call center roles, preferably within healthcare.
• Associate’s degree or equivalent; additional healthcare business education preferred.

Responsibilities

• Effectively reviews and resolves credentialing/enrollment and contracting tasks.
• Provides data for Credentialing Team in reports and claims for provider enrollment.
• Monitors credentialing status and communicates with Credentialing Specialists.
• Ensures confidentiality of patient and company information per HIPAA and compliance standards.

Skills

Credentialing

Insurance Claims

Communication

Education

Associate’s degree

Job description

Essential Job Functions

• Effectively reviews and resolves credentialing/enrollment and contracting tasks.
• Provides data for Credentialing Team in the form of reports and claims required for provider enrollment with various insurance plans.
• Accurately monitor and communicate with Credentialing Specialists.
• Analyzes trend impacting charges.
• Effectively navigate payer portals to verify insurance eligibility and to identify the difference between payer plans.
• Professionally communicate claim denials with insurance payers to determine accurate denial information for resolution.
• Appropriately update denied claims and file for resubmission.
• Monitors provider enrollment status and responds to credentialing and enrollment discrepancies.
• Ensures and maintains the confidentiality of patient information and other company information in accordance with HIPAA and other compliance standards.
• Performs other duties as directed.
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

Key Success Indicators/Attributes

• Ability to prioritize and multi-task in a fast-paced, changing environment.
• Demonstrate ability to work in all work types and specialties.
• Demonstrate ability to self-motivate, set goals, and meet deadlines.
• Demonstrate problem-solving skills and the ability to think critically to identify and implement appropriate solutions.
• Demonstrate excellent verbal communication skills, with the ability to effectively communicate contracting discrepancies to department leadership for review and resolution.
• Strong active listening skills to understand patient concerns and provide appropriate resolutions.
• Maintain courteous and professional working relationships with employees at all levels of the organization.
• Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.
• Ability to remain calm and composed in stressful situations, and effectively de-escalate any conflicts or disputes.
• Compassionate and empathetic personality to handle patient inquiries and concerns with sensitivity and professionalism.
• Skill in operating a personal computer and utilizing a variety of software applications is essential.

Qualifications

Required Education and Experience

• Minimum of 3-5 years prior experience in insurance follow up and/or credentialing and enrollment.
• Associate’s degree or equivalent, additional education in healthcare business preferred.
• Proven experience in a customer service or call center role, preferably within the healthcare industry.

Required Skills

• Hospital Credentialing
• Insurance Claims

About Us

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com

We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. Benefits and incentive eligibility may vary based on position, location, and tenure.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcarealso prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at [e-mail] .