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Payer Enrollment/Credentialing Specialist
Advanced Urology Snellville, GA
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$36k-44k (estimate)
Full Time 3 Days Ago
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Advanced Urology is Hiring a Payer Enrollment/Credentialing Specialist Near Snellville, GA

Job Description

Job Description

MISSION

The Managed Care & Payer Enrollment Specialist is responsible for maintaining individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.

OUTCOMES

  • Complete and communicate network participation forms with various payers and provider enrollments with clearinghouse
  • Complete revalidation requests and credentialing/re-credentialing applications to add providers for commercial and government payers, including Medicare and Medicaid.
  • Coordinate with CINs to ensure provider credentialing and enrollment applications are submitted timely and accurately
  • Apply and update each provider’s accurate service enrollment with Medicaid via GAMMIS and CAQH database file timely according to the schedule published by CMS
  • Work closely with all departments within and outside the organization to identify and resolve any denials or authorization issues related to provider credentialing or payer enrollment
  • Maintain internal provider grid to ensure all information is accurate and logins are available
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases, including Tax ID and NPI
  • Able to effectively conduct research while managing various other functions
  • Perform other projects and duties as assigned

COMPETENCIES

Job Related Competencies:

  1. Action Oriented: Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
  2. Plans and Aligns: Planning and prioritizing work to meet commitment aligned with organizational goals.
  3. Interpersonal Savvy: Relating openly and comfortably with diverse groups of people.
  4. Manages Complexity: Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.

QUALIFICATIONS

Basic Qualifications:

Education:

  • High School Diploma

Previous, Job Relevant Work Experience:

  • Knowledge of medical terminology, medical insurance carrier policies/procedures and state/federal rules and regulations
  • Knowledge of facility credentialing for ancillary and physician services (
  • Knowledge of Medicare, Medicaid, and Commercial Payer provider enrollment
  • Proficiency in Microsoft Office Suite/Office 365 (particularly Excel and Word)
  • Ability to manage multiple concurrent tasks
  • Professional written and verbal communication and interpersonal skills and ability to communicate effectively with team members, supervisors, client staff and insurance contacts

Preferred Qualifications:

Education:

  • Bachelor’s Degree

Previous, Job Relevant Work Experience:

  • Working knowledge of working in eCW, Modio, GAMMIS, PECOS, CAQH, and NPPES system/program
  • 2 years of working in a medical services organization

Job Summary

JOB TYPE

Full Time

SALARY

$36k-44k (estimate)

POST DATE

05/02/2024

EXPIRATION DATE

05/15/2024

WEBSITE

advanceduro.com

HEADQUARTERS

WARREN, OH

SIZE

25 - 50

FOUNDED

1995

REVENUE

<$5M

INDUSTRY

Ambulatory Healthcare Services

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