Provider Payer Enrollment Credentialing Specialist

Community Medical Services; Scottsdale (AZ); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Subsidized medical, dental, and vision

Health savings account

Short and long-term disability

Life insurance

Paid sick, vacation, and holiday time

401K retirement plan with match

Tuition and CME reimbursement up to 百

Job summary

Community Medical Services (CMS) is hiring a Credentialing Administrator. Under supervision of the Credentialing Admin Supervisor, the role maintains credentialing records, files and reports for physicians, nurses and facilities, and prepares applications for payer enrollment and recredentialing.

This is a hybrid role with in-office work on Tuesday-Thursday and remote work on Monday and Friday in a fast-paced environment.

Qualifications

• Minimum education of high school diploma or GED; associates/bachelor preferred.
• At least 3 years healthcare credentialing and enrollment experience.
• Familiarity with healthcare industry and payer enrollment processes.
• Proficient with PDF, Microsoft Word, Excel and data entry; ability to learn new systems.
• Strong written and verbal communication; able to multitask in a deadline-driven environment.

Responsibilities

• Compile and process provider documents for payer and facility enrollment.
• Maintain provider data and monitor progress across credentialing cycles.
• Ensure complete verification of credentials and eligibility.
• Coordinate data collection from cross-functional teams for credentialing files.
• Load rendering providers into CMS EMR/EHR systems.
• Navigate state and federal payer websites to submit enrollments.

Skills

Credentialing

Healthcare experience

Microsoft Office

Data entry

Communication skills

Education

High school diploma or GED

Associates or Bachelor's degree preferred

Tools

Pecos

I&A

NPPES

APE P

CAQH

Availity

Job description

Description

This is a hybrid role in office on Tuesday-Thursday and working from home on Monday and Friday

Community Medical Services (CMS) is hiring a Credentialing Administrator. Under the supervision of the Credentialing Admin Supervisor, the Credentialing Administrator is responsible for maintaining credentialing records, files and reports for all staffed physicians, nurses, licensed counselors and all CMS facilities. This role will also prepare and submit required credentialing applications and primary source documents to state, federal and statement Health Maintenance Organizations for initial and reappointment credentialing and payer enrollment or providers and facilities. This candidate will work collaboratively with several cross-functional teams in our fast-paced, deadline-driven environment.

As part of our mission to help individuals recover from substance use disorders, you’ll thrive in a supportive, engaging, and fulfilling work environment where your contributions are valued.

Along the way, we’ll invest in your well-being through a benefits package for full-time employees that includes:

• Subsidized medical, dental, and vision insurance
• Health savings account
• Short and long-term disability insurance
• Life insurance
• Paid sick, vacation, and holiday time
• 401K retirement plan with match
• Tuition and CME reimbursement up to 100%
• Employee assistance program to support your mental health and wellness
• Ongoing professional development

Responsibilities:

• Compiles and processes provider documents to submit applications for payer and facility enrollment in compliance with federal, state, managed care, and regional requirements.
• Maintains provider data to monitor applicant progress in the credentialing/enrollment/recredentialing process with Federal, State and Managed Care organizations.
• Ensures consistent documentation and complete verification of provider credentials.
• Coordinates data collection from cross functional teams to be included in the credentialing files. Monitors the recruitment status of provider staff candidates to ensure timely credentialing submissions to State Medicaid Agencies, Medicare and HMO’s.
• Maintains credential and peer review files, e.g. keeps all licensure, certifications, etc. current.
• Loads all applicable rendering providers into CMS Electronic Medical Record System and Electronic Health Record System.
• Has utilized the following data bases to manage the providers enrollments Pecos, I&A, NPPES, APEP, CAQH and Availity
• Able to navigate each of the health plans websites to submit payor enrollments or provider and facility (i.e, Medicare, State Medicaid/AHCCCS, UHC/Optum, BCBS, Cigna, Humana and Aetna )
• Medicare and Medicare revalidations according to each state level
• Identifies issues that require additional investigation and evaluation; validates discrepancies and ensures appropriate follow ups
• Interface with state and federal agencies such as, Medicare, Commercial and Medicaid Health plans, providers , facility, licensing agencies on a regular basis.
• Use critical thinking skills to conduct follow-up with individual practitioners internal and external entities to resolve discrepancies identified during the credentialing process

Requirements

• Requires an education level of at least a high school diploma or GED. Associates or Bachelor degree preferred.
• At least 3 years healthcare credentialing and enrollment experience is required.
• Basic familiarity with healthcare / medical industry is required.
• Computer skills to include PDF, Microsoft Word, Excel and basic data entry, including the ability to learn new and complex
• computer system applications.
• Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

Tools and Equipment Requirements:

• The ability to use a phone, computer, printer, and copier is required.
• Frequent use of Microsoft office products, including but not limited to Outlook, Word, Excel, and PowerPoint.
• The ability to use the internet and various web browser software is required.

Physical Working Conditions and Office Setting Description:

• Requires sitting and standing associated with a normal office environment.
• Manual dexterity using a calculator and computer keyboard.
• Requires prolonged sitting, standing, frequent bending, stooping, or stretching.
• Some lifting may be required.
• Frequent and prolonged typing and frequent and prolonged operation of computer, keyboard, and telephones required.
• Requires occasional use of fax machines, telephones, copiers, and other office equipment.
• Employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and or move up to 50 pounds.

#CRPSF

About Community Medical Services

Community Medical Services (CMS) is a CARF-accredited addiction treatment program providing services in the form of outpatient medication-assisted treatment and one-on-one and group counseling to those seeking help with their opioid use disorder. Headquartered in Arizona with more than 70 treatment clinics in 14 states, CMS is dedicated to meeting the challenges presented by the growing opioid epidemic in communities where treatment is lacking.

Our Commitment

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Other Conditions

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.