POSITION SUMMARY:
Responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers.
ESSENTIAL FUNCTIONS:
- Manage the completion and submission of provider enrollment applications
- Maintain documentation and reporting regarding provider enrollments in process
- Retain records related to completed provider enrollments.
- Maintain provider enrollment information within the credentialing database
- Interact professionally with providers, ancillary staff and plan representatives to provide appropriate and timely response to inquiries and concerns regarding provider
- Respond to inquiries regarding status of applications received
- Follow up with insurance plans to monitor status of provider applications
- Research and contact providers to resolve enrollment application deficiencies
- Send out provider applications, forms and other provider correspondence as requested
- Maintain strict confidentiality of information as dictated by current HIPAA requirements
OTHER WORK RELATED FUNCTIONS:
- Team with peers for effective and efficient work flow
- Obtain and/or enter information in a timely and efficient manner
- Participate in departmental meetings
- Other duties as assigned
POSITION QUALIFICATION & SKILLS:
Educational Equivalent: High School Diploma, AA preferred
Skills:
- Problem solving skills for the identification of issues and the ability to develop appropriate courses of action
- Proficient computer skills
- General office skills
- Excellent verbal and written communication skills
- Excellent organizational skills for prioritizing tasks to meet set deadlines
- Excellent cognitive and judgment skills
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