The Credentialing Associate is responsible for assisting the Credentialing Specialist with the enrollment and credentialing of all licensed medical, dental, and behavioral health providers in accordance with internal guidelines and established requirements of various health plans and managed care organizations. Essential duties and responsibilities will include:
Assist with tracking insurance credentialing requests from start to finish following standard operating procedures.
Maintains up to date electronic status of enrollment utilizing tools and processes provided. Monitors the progress of enrollment and performs follow-up activities needed.
Communicates with insurance carriers, physicians and mid-level providers to ensure contractual and regulatory compliance and insurance credentialing is completed timely.
Assist with completing provider enrollment forms confirming provider’s information and maintains contracts and enrollment forms enforcing compliance based on the specific requirements.
Assist with preparation of status reports and responding to verbal and written communications.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Ensures health center addresses are current with health plans, agencies and other entities.
Maintains confidentiality of provider information.
Other related duties as assigned.
Minimum High School diploma or equivalent
2+ years experience in a managed care environment with primary focus on credentialing physicians/facilities as a requirement. Certification as a Certified Provider Credentialing Specialist (CPCS) preferred
Experience working in an office setting, preferably in the community health care industry
Experience working with databases, Microsoft Excel
Must be able to multi-task and work in a fast paced environment
Strong follow up, interpersonal and communication skills
Must be flexible with the ability to work well in a team environment
Strong analytical skills, and problem solving skills