MODENA

Credentialing Specialist

• The Credentialing & Enrollments Specialist is responsible for managing the credentialing, payer enrollment, and provider onboarding processes for the practice’s physicians and advanced practice providers.
• This role ensures providers are credentialed, enrolled, and maintained with commercial and government payers in a timely and accurate manner to support uninterrupted billing and patient care operations.
• The specialist maintains provider records, monitors credentialing deadlines, coordinates with payers and providers, and serves as a key resource for credentialing and insurance operations.
• This position requires strong organizational skills, attention to detail, and the ability to manage multiple deadlines in a fast-paced healthcare environment.
• This role is non-exempt (hourly) and full-time, 40 hours per week, Monday through Friday. Occasional overtime may be required to meet credentialing deadlines or business needs.

Credentialing and Enrollments Specialist

Clinical Operations

• Develop, implement, and continuously improve standardized protocols for key clinical procedures.
• Conduct regular audits, observations, and quality checks on nursing and clinical staff performance.
• Identify opportunities for process enhancement to reduce errors, improve patient throughput, and enhance safety.
• Ensure full compliance with OSHA, HIPAA, AAAAI guidelines, and all applicable state and federal regulations.
• Lead training programs and competency assessments for clinical staff on procedures and best practices.
• Investigate incidents, near-misses, and patient complaints related to clinical processes and implement corrective action plans.
• MIPS reporting, data collection, and submission to maximize incentives and maintain compliance.
• Assist the development of online training programs for front office, managers, and nursing staff.
• Monitor and optimize front office performance metrics.
• Establish key performance indicators (KPIs) and dashboards for both clinical and administrative teams.
• Perform regular audits of documentation, billing accuracy, and workflow efficiency.
• Collaborate with the Medical Director, Practice Administrator, and department leads to align quality goals with overall clinic objectives.

Credentialing and Enrollments Specialist

Clinical Quality Control and Process Improvement Manager