What are the responsibilities and job description for the Provider Enrollment & Credentialing Specialist position at Buckeye Global?
We are seeking a detail-oriented Provider Enrollment & Credentialing Specialist
to manage healthcare provider enrollment, re-credentialing, and compliance documentation. This position is responsible for gathering and verifying healthcare practitioner information, processing enrollment applications, maintaining accurate provider records, and ensuring timely submission of required documentation to insurance payers.
The ideal candidate will have experience in medical insurance verification, provider relations, or healthcare billing, along with knowledge of Medicare, Medicaid, CAQH, and payer enrollment processes.
Key Responsibilities**Provider Enrollment & Re-Credentialing
**
Review, prepare, and process new hire provider enrollment packets, ensuring accuracy, completeness, and timely submission to insurance payers.
Collect and verify required provider documentation, including professional licenses, certifications, and other credentialing records.
Coordinate with physicians to obtain missing documentation and complete enrollment and re-credentialing applications.
Send renewal reminders at least 30 days before credential expiration.
Complete CAQH re-attestations every 120 days for all providers.
**Provider Database & Compliance Management
**
Maintain accurate and up-to-date provider information in internal databases, CAQH, and the National Plan and Provider Enumeration System (NPPES).
Update provider service locations, rendering provider details, licensure, and ownership information.
Maintain credentialing files, scan supporting documents, and monitor license and certification expiration dates.
Notify administrators and the Enrollment Manager of upcoming deadlines and compliance requirements.
Stay informed about payer enrollment procedures, policy changes, and documentation requirements.
**Payer Coordination & Follow-Up
**
Communicate with insurance payers through phone calls, emails, letters, and other correspondence to track enrollment applications.
Follow up to obtain provider participation effective dates and identification numbers, targeting completion within 60 days of payer receipt of the application.
Maintain detailed records of all payer communications, application updates, and written correspondence.
Resolve enrollment discrepancies and help prevent reimbursement delays.
**Billing Support & Claims Resolution
**
Collaborate with the Billing Department to research and resolve claims issues related to provider enrollment and credentialing.
Verify provider participation status, effective dates, and payer information to support accurate and timely reimbursement.
Coordinate with internal stakeholders to address enrollment-related billing concerns.
**Experience
**
Minimum of 2 years of experience in medical insurance verification, healthcare billing, and/or provider relations.
Working knowledge of insurance billing and provider operations within a large healthcare organization.
Knowledge of Medicare and Medicaid policies, procedures, and enrollment requirements.
**Technical Skills
**
Knowledge of ECHO, NaviNet, and CAQH systems.
Familiarity with provider enrollment, re-credentialing, and insurance verification processes.
Basic proficiency in Microsoft Word, Excel, and PowerPoint.
Ability to maintain accurate provider records and track credentialing deadlines.
You should be proficient in:
- ISO 22000
- CAQH
- ECHO
- NaviNet
- NPPES
- Provider Credentialing
- Provider Enrollment
- Re-Credentialing
Salary : $25 - $30