JOB TITLE : Provider Enrollment Specialist / Credentialing

SUPERVISION RECEIVED : Reports to Provider Enrollment Manager. LOCATION : Metairie, LA GENERAL SUMMARY OF DUTIES : Responsible for all aspects of the credentialing, re-credentialing, and contracting processes for medical providers in private practice or group settings.

ESSENTIAL FUNCTIONS :

• Prepare and submit Governmental and Private Carrier applications for initial submission and re-credentialing and follow-up as needed.
• Acquire and process new Managed Care Agreements.
• Maintain detailed log of all pending and completed work.
• Apply and update NPI Numbers through the NPI Website.
• Apply and maintain EDI, EFT & ERA processes.
• Maintains strictest confidentiality.
• Follows established policies and procedures listed in the Employee Handbook, ACS Practice Management, Compliance and HIPPA Manuals.
• The job holder must demonstrate competencies applicable to the job position while performing duties in a professional and courteous manner.

EDUCATION :

High school diploma or GED.

SKILLS & KNOWLEDGE :

• Knowledge and understanding of the credentialing / enrollment process.
• Knowledge of Governmental and Private Provider enrollment processes and applications for Louisiana and other States.
• Knowledge of CMS Federal and State Guidelines.
• Knowledge of Prime Source Verification.
• Knowledge of CAQH.
• Proficient use of Microsoft Office Word, Excel, and Outlook.
• Knowledge of grammar, spelling and punctuation to type correspondence.

ABILITIES :

• Ability to read, understand and follow oral and written instruction.
• Ability to sort and file materials correctly by alphabetic or numeric systems.
• Ability to organize and prioritize work and manage multiple priorities.
• Ability to establish and maintain effective working relationships with patients, employees and the public.

Last updated : 2024-02-23