Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our Physician Excellence team to fill the role of Provider Enrollment Specialist. We are a 100% remote team supporting our Physician clients across the United States! See us at www.quadristeam.com
Job Focus
The experienced Provider Enrollment-Credentialing Specialist will perform facility and health plan credentialing for Physicians, Nurse Practitioners and PA's and work independently to coordinate, develop, monitor, and maintain the credentialing process. This position is responsible for assessing current credentialing status of all employed and independently contracted provider's, complete facility and payer applications as needed and work with leadership to ensure all provider credentialing is properly managed.
The Credentialing Specialist will be responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care, clinics, and facilities. In this role, the Credentialing Specialist will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities and maintain up-to-date data for each provider in credentialing databases and online systems.
Enrollments with various payors and insurance companies (initial, recredentialing, and change of info), maintaining accounts CAQH, Availity, PECOS, Medicaid, researching errors in credentialing that affect claims, assist with facility privileging, adding new products lines/addendums to established insurance contracts and establishing new contracts as needed. All tasks are both group and individual enrollments.
Primary - Essential Expectations For Success
Salary: $19.00 - $23.00 per hour
Job Focus
The experienced Provider Enrollment-Credentialing Specialist will perform facility and health plan credentialing for Physicians, Nurse Practitioners and PA's and work independently to coordinate, develop, monitor, and maintain the credentialing process. This position is responsible for assessing current credentialing status of all employed and independently contracted provider's, complete facility and payer applications as needed and work with leadership to ensure all provider credentialing is properly managed.
The Credentialing Specialist will be responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care, clinics, and facilities. In this role, the Credentialing Specialist will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities and maintain up-to-date data for each provider in credentialing databases and online systems.
Enrollments with various payors and insurance companies (initial, recredentialing, and change of info), maintaining accounts CAQH, Availity, PECOS, Medicaid, researching errors in credentialing that affect claims, assist with facility privileging, adding new products lines/addendums to established insurance contracts and establishing new contracts as needed. All tasks are both group and individual enrollments.
Primary - Essential Expectations For Success
- Responsible for implementation and oversight of all activities related to payer enrollment for providers.
- Responsible for development of payer enrollment policies and procedures.
- Maintains knowledge of facility and payer credentialing requirements.
- Prepares reports from credentialing database and provides communication regarding credentialing status
- Coordinates and manages the dissemination to health plans and other payers.
- Other tasks / projects as assigned by leadership.
- PECOS/Medicare Enrollments
- Engage with Physician Clients
- Provider Licensing
- Preferred CPES or CPCS Certification through NAMSS National Professional Organization
- Maintaining / Updating Provider Profiles CAQH/NPPES
- Facility Enrollment
- Multistate Payer Enrollment all Payers
- Trends / tracking and maintaining database
- Maintains compliance with regulations and laws applicable to job
- Professional level communication expectations with video, phone and email
- Ability to effectively prioritize the work to meet deadlines and expectations
- Meets the quality and productivity measures as outlined by Quadris
- Brings positive energy to the work
- Uses critical thinking skills
- Being present at work and reducing distractions
- Being a self-starter
- Incredible attention to detail
- High School diploma or equivalent
- 2+ years previous experience in healthcare Payer Enrollment and Credentialing
- Proven experience credentialing MD's, DO's, NP's & PA's directly with Medicare, Medicaid, Commercial health plans and other private insurance companies to increase revenue
- Ability to work independently and within a team atmosphere
- Prefer working proficiency of CPT and ICD-10, and general knowledge of healthcare Revenue Cycle Mgmt
- Self-motivated and passionate about our mission and values of quality work
- Must have professional level skills in MS products such as Excel, Word, Power Point.
- Must be able to type proficiently and with an effective pace
- Proficient application of business/office standard processes and technical applications
- Prolonged periods of sitting at a desk and working from a computer
- Must be able to lift 15 pounds at one time
- Must be able to structure your home office to ensure patient information is secure, meeting the regulatory expectations
Salary: $19.00 - $23.00 per hour