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About the role
Key responsibilities & impact- Responsible for coordinating requests for participation in health insurance network as a medical provider
- Monitoring and maintaining provider enrollment and re-enrollment process in a timely and compliant manner
- Reviewing provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements
- Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner
- Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others
- Maintains positive working relationships with providers
- Plays an active role in explaining providers and practice/office managers the submission requirements for credentialing/recredentialing processes
- Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
- Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data
- Proactively obtains updated provider credentialing data prior to expiration
- Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
- Completes all additions, updates, and deletions
- Supports new provider onboarding processes as related to enrollment
- Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner
- Fosters working relationships and teamwork with departments, vendors, etc.
- Develops databases and spreadsheets for tracking organization providers
- Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management
- Continuously searches for process improvements to achieve accuracy and efficiencies
- Performs other duties as assigned or required
Requirements
What you’ll need- California market experience is key
- Must have experience with Department of Labor enrollments
- Healthstream experience is preferred
- Prior experience with internal auditing is key
- CAQH experience is a plus
- High School Diploma or equivalent
- 5 years' experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements
- Proficiency in Microsoft Word, Excel, Outlook, PDF Software and other management tools
- Motivated to quickly learn and demonstrate strong problem-solving skills
- Strong project management and multitasking skills
- Excellent interpersonal and communication skills
- Strong writing skills and attention to detail
- Strong organizational skills and ability to be attentive to details
- Demonstrated knowledge of healthcare contracts preferred
Benefits
Comp & perks- Joining comes with an array of benefits
- flexible work hours when possible
- genuine sense of belonging to a dynamic and growing organization
- Access to a 401(k) Retirement Savings Plan
- Comprehensive Medical, Dental, and Vision Coverage
- Paid Time Off
- Paid Holidays
- Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider enrollmentcredentialingrecredentialingprimary source verificationdata analysisinternal auditingpayer billing requirementsclaims processingdatabase developmentprocess improvement
Soft Skills
problem-solvingproject managementmultitaskinginterpersonal skillscommunication skillswriting skillsattention to detailorganizational skillsteamworkrelationship management
Certifications
High School DiplomaCAQH certification