Specialist-Payer Enrollment

Baptist Memorial Health Care; Memphis (TN); On-site; USD 38,000 - 60,000; Full time

Job summary

Baptist Memorial Health Care in Memphis, TN seeks a Credentialing Specialist to generate enrollment or affiliation applications and ensure accuracy before submission. You will follow established workflows, respond to payer or facility requests, and support credentialing verifications for physicians and mid-level providers joining Baptist Medical Group.

The role involves data entry, primary data source verification, CAQH attestation, and reporting, with emphasis on confidentiality and accuracy.

Qualifications

• 2 years credentialing experience in a medical billing organization.
• Strong verbal and written communication skills.
• Proficient in Microsoft Office; typing 35 wpm.
• Knowledge of CAQH, AMA, NPDB; primary data source verification preferred.
• Payer enrollment experience preferred.

Responsibilities

• Maintains current knowledge of credentialing practices and standards.
• Completes government and commercial insurance enrollment applications for new and established providers within BMG and BMG Foundations.
• Provides excellent service to patients, providers, payers, clinic staff, Physician Revenue Cycle staff, Operations and Administration.
• Maintains current licensure, DEA, certifications, board certifications and all other credentialing documents.
• Reviews EPIC's related to payer enrollment on a daily basis.
• Completes assigned goals.

Skills

Excellent communication

CAQH knowledge

Payer enrollment experience

Education

High School/GED

Medical Billing and Coding Diploma

Tools

Microsoft Office

Job description

Job Summary

Generates enrollment or affiliation applications to submit per established protocols. Reviews for accuracy all enrollment applications and re-credentialing documents prior to submission. Follows established workflows to ensure that proper enrollments are submitted and that timely follow up is performed. This includes prompt response to follow up requests from payers or facilities. Assists in continuous reevaluation of workflows to ensure efficient processes are being followed. Supports the Manager and Director in the efforts to confirm the credentials and primary data source verifications of physicians and mid-level providers joining Baptist Medical Group. Communicates directly with providers, payers, clinic personnel, Operation Directors and Managers and Executive Directors as needed. Generates reports. Performs data entry. Performs primary data source verification. Performs CAQH attestation. Each function requires the highest level of accuracy and confidentiality.

Responsibilities

• Maintains current knowledge of credentialing practices and standards.
• Completes government and commercial insurance enrollment applications for new and established providers within BMG and BMG Foundations.
• Provides excellent service to all customers: patients, providers, payers, clinic staff, Physician Revenue Cycle staff, Operations and Administration.
• Maintains current licensure, DEA, certifications, board certifications and all other credentialing documents.
• Reviews EPIC's related to payer enrollment on a daily basis.
• Completes assigned goals.

Experience

#N/A

Minimum Required Experience

2 years focused credentialing experience in a medical billing organization.

Preferred/Desired Experience

None

Education

• Minimum Required: High School/GED
• Preferred/Desired: Medical Billing and Coding Diploma from an accredited facility.

Training

• Minimum Required: Proficient in Microsoft Office. Ability to type 35 wpm.

Special Skills

• Minimum Required: Excellent skills in verbal and written communication.
• Preferred/Desired: Working knowledge of CAQH, AMA, NPDB, and primary data source verification. Specific knowledge of payer enrollment application process.