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Credentialing & Payer Enrollment Specialist - Buckhead
Atlanta, GAPosted 2 days ago
remote
Job Description
Job Id:
6086
# of Openings:
1
We are a thriving Outpatient Pain Management Practice who seeks qualified, dynamic Healthcare Professionals like you! No weekends, 8 Major Holidays off, no overnights and you'll never be On-Call!
Job Summary
This position requires a strong teamwork orientation, solid verbal & written communication skills, and stellar attention to detail. Responsible for completing defect-free and timely payor enrollment activities for all medical providers who provide patient care at centers and medical practices owned and/or managed by ASPC. Maintain up-to-date data for each provider in online systems such as Qgenda and Smartsheet; ensure timely renewal of all associated applications within the scope of payer enrollment. Works with payors on issues resolution, and provider roster loads.
Essential Duties and Responsibilities
- Provider Onboarding/Initial Communication Point for New Providers
- Processes internal (ASC) and external (Facilities) credentialing and re-credentialing applications; Primary Source Verification, and monitors applications and follows-up.
- Maintains and tracks state licenses, DEA, and other certifications required for credentialing
- Maintains current knowledge of payer enrollment guidelines and standards.
- Accurately Review and completes government and commercial payor enrollments for the state of Georgia i.e., Medicare, Medicaid, Commercial carriers, workers comp, and any additional related forms in order to achieve successful enrollment and re-enrollment outcomes in a timely and defect-free manner with payors for new and established providers.
- Provide excellent service to all providers, payers, clinic staff, Physician Revenue Cycle staff, Operations and Administration.
- Works with payors on issues resolution, and provider roster loads confirmation.
- Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within and time frames within Enrollment Software.
- Follows established workflows to ensure that proper enrollments are submitted and that timely follow up is performed. This includes prompt response to follow up requests from payers.
- Communicates directly with providers, payers, clinic personnel, Operation Directors and Managers and Executive Directors as needed.
- Generates reports. Performs data entry.
- Performs CAQH attestation.
- Provider File Compliance Maintenance (i.e., JCAHO, State)
- Escalates matters that may impede the process of timely enrollment with payors.
- Each function requires the highest level of accuracy and confidentiality.
- Performs other duties as assigned.
Education/Experience/Skills/Certifications
High school diploma or GED required. Certified Provider Credentialing Specialist (CPCS) preferred. Two years of relevant credentialing experience.
Knowledge and understanding of the credentialing process. Ability to organize and prioritize work and manage multiple priorities. Excellent verbal and written communication skills including letters, memos and emails. Excellent attention.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Possible exposure to infectious/contagious disease, hazardous chemicals and materials, needle sticks, blood and body fluids.
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