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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