Job Description
Remote Provider Enrollment and Credentialing Specialist - Location: York, Pennsylvania
- Type: Contract
- Job #79251
APR Consulting, Inc. has been engaged to identify a
Remote Provider Enrollment and Credentialing Specialist Location: York, PA 17403-3676 / Remote
Position: Remote Provider Enrollment and Credentialing Specialist Pay Rate: $25.86/hr
Duration: 26 weeks with possibility of extension
SHIFT: Monday - Friday 8a-5p EST (must work EST hours)
- Facility will provide a laptop and equipment
- Candidate must have access to reliable highspeed internet & a dedicated workspace
JOB SUMMARY: Maintains close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing, recredentialing and reappointments through the different entities, Credentials Committee and Board of Directors Meetings. This role will focus more on enrollment than credentialing.
JOB RESPONSIBILITIES
Processes initial provider enrollment with payers, initial credentialing and recredentialing:
o Creates, assembles and prepares application packet for providers to complete, reappointment applications for hospitals Health entities and submits applications to payers.
o Completes primary source verifying provider credentials per established policies and procedures.
o Enters provider credentials and application requirements into Cactus, CAQH.
o Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank.
o Adheres to all policies and procedures regarding mandated queries and reporting mechanisms.
o Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities.
o Reviews and conducts QA checks on the applications prior to medical director's review.
o Re-attests provider information every 120 days in CAQH.
o Runs reports and complete Medicare and Medicaid revalidations for Medical Group & Hospital Based providers.
o Maintains confidentiality of provider information.
Data Management
o Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers.
o Runs weekly Credentialing Update reports to IS Department for billing system update.
o Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly.
o Assists with helping resolve claim issues by contacting applicable provider reps.
Change letters
o Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements.
Maintains established policies and procedures, objectives, quality assessment and safety standards.
Maintains professional growth and development.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Performs other related duties as identified.
Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.
MINIMUM REQUIREMENTS
High school diploma or GED REQUIRED.
Associates Degree PREFERRED.
2 years relevant work experience in medical staff enrollment &/or credentialing REQUIRED.
Hospital/physician office/insurance claims or credentialing experience PREFERRED.
Cactus experience STRONGLY PREFERRED.
Ability to multi-task and work independently by prioritizing work load.
High level of organizational skills.
Proficiency in data entry.
Ability to handle interruptions such as phone calls, emails and meetings.
Excellent computer skills.
Excellent communication/interpersonal skills.
Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!APR Consulting
Job Tags
Contract work, Work experience placement, Locum, Shift work, Monday to Friday,