Provider Enrollment & Credentialing Specialist

The <\/span>Provider <\/span>Enrollment & <\/span>Credentialing <\/span>Specialist <\/span>will <\/span>be <\/span>responsible <\/span>for <\/span>the <\/span>full -<\/span>cycle <\/span>credentialing <\/span>and <\/span>enrollment <\/span>of <\/span>our <\/span>healthcare <\/span>providers, <\/span>including <\/span>physicians <\/span>and <\/span>mid -<\/span>level <\/span>practitioners. <\/span>This <\/span>role <\/span>is <\/span>vital <\/span>to <\/span>ensuring <\/span>that <\/span>our <\/span>clinical <\/span>staff <\/span>are <\/span>enrolled <\/span>with <\/span>payers, <\/span>credentialed <\/span>with <\/span>facilities, <\/span>and <\/span>compliant <\/span>with <\/span>all <\/span>regulatory <\/span>and <\/span>operational <\/span>standards.<\/span>
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Key <\/span>Responsibilities:<\/span><\/b>
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• Manage <\/span>the <\/span>credentialing <\/span>and <\/span>re -<\/span>credentialing <\/span>processes <\/span>for <\/span>physicians, <\/span>nurse <\/span>practitioners, <\/span>and <\/span>physician <\/span>assistants.<\/span>
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• Enroll <\/span>new <\/span>providers <\/span>with <\/span>Medicare, <\/span>Medicaid, <\/span>and <\/span>commercial <\/span>insurance <\/span>plans.<\/span>
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• Maintain <\/span>accurate <\/span>and <\/span>up -<\/span>to -<\/span>date <\/span>provider <\/span>information <\/span>in <\/span>internal <\/span>databases <\/span>and <\/span>with <\/span>payer <\/span>systems.<\/span>
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• Track <\/span>expirables (<\/span>e.<\/span>g., <\/span>licenses, <\/span>certifications, <\/span>malpractice <\/span>insurance) <\/span>and <\/span>ensure <\/span>timely <\/span>renewals.<\/span>
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• Communicate <\/span>with <\/span>providers <\/span>and <\/span>internal <\/span>departments <\/span>to <\/span>gather <\/span>necessary <\/span>documentation <\/span>and <\/span>resolve <\/span>enrollment <\/span>or <\/span>credentialing <\/span>issues.<\/span>
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• Monitor <\/span>and <\/span>respond <\/span>to <\/span>payer <\/span>requests <\/span>and <\/span>follow <\/span>up <\/span>to <\/span>ensure <\/span>timely <\/span>processing.<\/span>
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• Stay <\/span>current <\/span>on <\/span>enrollment <\/span>and <\/span>credentialing <\/span>regulations <\/span>and <\/span>payer <\/span>requirements.<\/span>
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• Support <\/span>facility <\/span>privileging <\/span>processes <\/span>when <\/span>applicable.<\/span>
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  Qualifications:<\/span><\/b>
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  • 2+ <\/span>years <\/span>of <\/span>experience <\/span>in <\/span>healthcare <\/span>credentialing <\/span>and/<\/span>or <\/span>provider <\/span>enrollment.<\/span>
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  • Familiarity <\/span>with <\/span>CAQH, <\/span>PECOS, <\/span>NPPES, <\/span>and <\/span>commercial <\/span>insurance <\/span>enrollment <\/span>processes.<\/span>
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  • Strong <\/span>organizational <\/span>skills <\/span>and <\/span>attention <\/span>to <\/span>detail.<\/span>
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  • Ability <\/span>to <\/span>work <\/span>independently <\/span>and <\/span>manage <\/span>multiple <\/span>tasks <\/span>and <\/span>deadlines.<\/span>
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  • Excellent <\/span>communication <\/span>skills, <\/span>both <\/span>written <\/span>and <\/span>verbal.<\/span>
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  • Experience <\/span>in <\/span>wound <\/span>care <\/span>or <\/span>with <\/span>mobile <\/span>healthcare <\/span>providers <\/span>is <\/span>a <\/span>plus.<\/span>
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    Preferred <\/span>Skills:<\/span><\/b>
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    • Knowledge <\/span>of <\/span>credentialing <\/span>software and<\/span> <\/span>platforms<\/span>.<\/span>
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    • Experience <\/span>working <\/span>with <\/span>a <\/span>geographically <\/span>distributed <\/span>provider <\/span>team.<\/span>
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    • Understanding <\/span>of <\/span>state <\/span>licensing <\/span>requirements <\/span>and <\/span>compliance <\/span>standards.<\/span>
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      Why <\/span>Join <\/span>Us?<\/span><\/b>
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      • Opportunity <\/span>to <\/span>be <\/span>part <\/span>of <\/span>a <\/span>mission -<\/span>driven <\/span>team <\/span>making <\/span>a <\/span>direct <\/span>impact <\/span>on <\/span>patient <\/span>care.<\/span>
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      • Supportive <\/span>and <\/span>collaborative <\/span>work <\/span>environment.<\/span>
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      • Competitive salary and benefits package.<\/span>
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