Credentialing/ Provider Enrollment Specialist

Credentialing/ Provider Enrollment Specialist (Full Time)(Full Time)

Location: Woonsocket, RI

Credentialing/ Provider Enrollment Specialist

(Full Time)

Position Summary

Coordinate, administer and maintain credentialing process for all eligible staff. Work with HR team to assist with HR duties as needed, including participation with the agency training committee for processing of CEUs and special trainings.

Qualifications

• Must have at least 3 years of credentialing and office experience in a health care setting.
• Minimum of high school diploma or equivalent.
• Ability to work in a fast-paced environment while remaining organized and handling multiple priorities simultaneously.
• Ability to work with a small but dynamic HR team.
• Excellent communication skills and ability to build strong relationships with employees from new hires to executive management.
• Flexible with strong problem-solving skills.
  
  

Primary Functions

• Complete all credentialing and re-credentialing duties and applications for agency.
• Assume full responsibility for maintaining, tracking and following up on any and all forms of licensure, certification, and credentialing documentation as required.
• Meet with all new hires with credentials or in the process of credentialing in order to get paperwork and licensure filed/requested with all insurance and funding sources.
• Work with finance to ensure all specified monetary increases/bonuses for employees with new credential qualifications are processed in a timely manner.
• Adhere to the credentialing requirements of all insurance/funding sources for which they qualify and provide Human Resources with the initial required documentation (licenses, liability insurance policies, DEA numbers etc.) and all renewals of these documents thereafter.
• Act as liaison between staff and insurance companies with regards to all credentialing correspondence.
• Work with billing team to ensure proper reimbursements are in place.
• Maintain up to date copies of staff licenses, certifications, DEAs, malpractice insurance and other provider information for credentialing and licensing.
• Attend Billing Team meetings to discuss any credentialing changes, updates or issues.
• Provide useful reports for management to be able to track where their staff are in the credentialing process
  
  

Secondary Functions

• Weekly dedicated time for filing of confidential employee documentation into personnel files.
• Assist HR team with tasks and projects possibly including Open Enrollment, career fairs, etc.
• Participate on Training Committee and work to support CEU processing.
• Other HR duties as assigned.
  
  

Benefits

Community Care Alliance offers competitive salaries based on experience, skills and performance,