Credentialing and Payer Enrollment Representative

The Credentialing and Payer Enrollment Representative will be knowledgeable in all areas of the credentialing and provider enrollment process. This person must be a good communicator, have attention to detail, self driven and managed, be a team player with a positive attitude and able to parse out time to accomplish all of the tasks each day. Below is a list of tasks that are assigned:

1. Payer Enrollment
a. Work closely with provider offices as well as provider relations representatives of various health plans to ensure payer enrollment tasks are completed in a timely fashion.
b. Telephone and email contact with insurance carriers and clients as needed for follow-up in a professional manner as needed.
c. Since contracting and credentialing are very intertwined, many of the items below will also pertain to credentialing items that are open.
d. Update Sharefile system with executed agreements as they become available.
e. Periodic EOB reviews for retainer clients.

2. Credentialing and Provider Enrollment
a. Work closely with provider offices as well as provider relations representatives of various health plans to ensure credentialing tasks are completed in a timely fashion.
b. Telephone and email contact with insurance carriers and clients as needed for follow-up in a professional manner as needed.
c. Documentation is ESSENTIAL as part of the key duties. Must speak and write good English.
d. Provide provider’s office at least 30 days notice of upcoming document expirations and document follow-ups.
e. Provide facilities with updated documentation and update CAQH as necessary.
f. Communication should be well written or verbalized in a professional manner.
g. Complete facility or insurance applications as necessary and follow-up through process with system documentation.
h. Work on outstanding items and make contact with plan or provider at preferred minimum of 2 weeks (3 weeks for health plans that are known to take up to 6 months or more to process will be permitted).

THIS IS NOT A BEGINNER JOB OR A TRAINING POSITION. MUST APPLY WITH A RESUME SHOWING RELEVANT U.S. EXPERIENCE WITH YOUR INQUIRY: