Provider Enrollment Rep II

Colonial Group; Louisville (TN); On-site; USD 45,000 - 60,000; Full time

Job summary

Colonial Group seeks a Credentialing Specialist to manage credentialing and recredentialing applications for insurance participation. You will track statuses, gather documents, and submit rosters to carriers to support delegation.

Responsibilities include data entry on CAQH and carrier sites, maintaining credentialing status, and handling network inquiries while keeping stakeholders informed. Strong Excel and credentialing software skills are required.

Qualifications

• High School Diploma or equivalent required.
• Dental or medical administration experience preferred.
• Basic computer skills including Excel required.

Responsibilities

• Complete and submit credentialing and recredentialing applications for insurance participation accurately and timely.
• Track application status until an effective date is set.
• Gather required documents and submit rosters to carriers to assist with delegation.
• Enter quarterly data on CAQH, TMHP, and other carrier websites as required.
• Maintain credentials and submit updated versions to keep status current.
• Triage inquiries about provider networks and update provider files as needed.
• Provide timely updates to stakeholders and perform other administrative duties.

Skills

Dental/medical administration

Education

High School Diploma or equivalent

Associate's Degree

Tools

Excel

Credentialing software

Google Suite

Job description

Responsibilities

• By following department guidelines, completes and submits credentialing and recredentialing applications for insurance participation in an accurate and timely manner.
• Tracks application status until an effective date is given. Tracks expiring provider credentials and communicates necessary updates appropriately and timely.
• Gathers required documents and submits rosters to carriers to assist with delegation.
• When prompted, enters current quarterly data on the national CAQH database, TMHP website, and other carrier websites as required.
• Collects and maintains all credentials and submits new versions when issues arise to keep credentialing status current.
• Triage and responds to departmental inquiries. This includes, but is not limited to, provider network status inquiries, updating provider files, and network changes.
• Communicates timely updates to stakeholders and performs various other administrative duties as needed.

Requirements

• High School Diploma or equivalent
• Dental or medical administration
• Computer, basic Excel

Preferred

• Associate's Degree
• Provider credentialing process
• Proficient in Excel, credentialing software, Google Suite