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Enrollment /Credentialing Specialist

Billing | Austin, TX (Frontera Crossing) | Full Time

Job Description

SCOPE

This position is responsible for facilitating a smooth enrollment process.   Administers the provider’s enrollment and application processes as well as prepares and submits applications and supporting documentation for the purpose of enrolling individual physicians, physician groups and facilities with payers. In addition, this position ensures the setup of clients for electronic claims submission and electronic remittance advice, follows up on the status of applications and tracks the progress on all pending applications. Interacts with a variety of people, including physicians and clinical staff, across multiple disciplines to obtain needed information.

ESSENTIAL FUNCTIONS

  • Create, collect, and maintain database information and manage the data process and documentation flow
  • Communicate with providers and payers via telephone or in writing to answer inquiries, gather further information, verify and/or resolve issues 
  • Prepare and/or process various types of enrollments, re-enrollments, and changes for providers while ensuring timely receipt of forms and verifying accuracy of information before submittal
  • Track enrollments with payers and follow up on outstanding confirmations
  • Document and distribute health plan provider numbers as received from payer
  • Review and resolve rejections and denials related to provider enrollment issues     
  • Access various systems to research and verify information
  • Maintain payer issue trackers for each plan and communicate ongoing issue status and resolution to interested parties; escalates issues as needed
  • Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner

 OTHER FUNCTIONS

  • Assist with special projects and assignments as necessary
  • This is not a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Supervisory Duties: No

KNOWLEDGE, SKILLS AND ABILITIES

  • High School diploma or G.E.D.
  • Excellent verbal and written communication skills
  • Strong attention to detail & organizational skills
  • Excellent customer service and interpersonal skills
  • Strong problem solving skills
  • Solid computer skills and knowledge of Microsoft Office programs
  • Ability to work in a team environment
  • Ability to manage competing priorities
  • Proven ability in completing accurate and thorough assignments in a timely manner
  • Two-five years of related experience 

Preferred Qualifications:

  • In-network contracting and credentialing and out-of-network enrollment/registration experience
  • Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT) enrollment experience
  • CPCS (Certified Provider Credentialing Specialist)

WORKING CONDITIONS

  • The employee will work in a standard office environment with repetitive use of a keyboard at a workstation. The employee may occasionally lift and/or move up to approximately 10 pounds. The noise level in the work environment is usually low to moderate.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform functions.