About The Role

Enrollment Specialist-1836

Essential Duties & Responsibilities

Initiates, coordinates and monitors the acquisition and receipt of all credentialing documentation from new and existing providers; provides follow-up and problem resolution as required ensuring eligibility to hospital and third-party insurance carriers.

Coordinates the processing, distribution, and management of all credentialing, privileging and accreditation documents.

Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

Requests, coordinates and conducts background investigations and license verifications in support of all physician credentialing/accreditation applications.

Develops and implements systems and procedures to ensure that all credentialing, privileging and accreditation processes are completed in accordance to relevant regulation, policies, standards and timeframes.

Compiles and maintains current and accurate data for all payers/providers

Completes provider initial and re-credentialing applications, provider change forms and letters and successfully following up with Third Party insurance carriers as needed.

Accesses and navigates PECOS, Medicaid, NPPES, CAQH and additional sites/portals as needed.

Adheres to detailed instructions regarding the application procedures for enrollment and entering this information into the credentialing database and/or spreadsheets.

Acts as first point of contact for insurance carriers; frequent email and phone communication.

Assists in completing tasks and workflows to successfully track follow-up efforts and statuses of applications submitted.

Interfaces regularly with administration regarding credentialing related inquiries and operations issues.

Maintains and ensures strict confidentiality of files and databases, specially with regards to any disciplinary actions or malpractice suits.

Processes requests for clinical privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.

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