Provider Enrollment Specialist

Seeking a full-time credentialing specialist to join our large pediatric multi-specialty practice. Flexible work hours available with the possibility of Hybrid schedule after 3 months. 

SUMMARY:  Coordinates all functions related to the credentialing and recredentialing of health care providers with both hospitals and payers and maintains provider credentialing files.

 

 DUTIES AND RESPONSIBILITIES:

• Receives and processes all initial credentialing and recredentialing applications.
• Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
• Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
• Maintains accurate and complete records of each application’s status.
• Enters all provider information into database.
• Prepares all documents to be reviewed by hospital Credentialing Committees
• Maintains all credentialing and recredentialing timelines and schedules.
• Maintains strict level of confidentiality on all matters pertaining to provider.
• Maintains well-organized provider files that are easily reviewed by credentialing committee, outside review bodies, and others.
• Processes approval, denial, or termination letters.
• Performs other related duties as assigned by management.