Position: Provider Enrollment / Credentialing Specialist
Location: Franklin, TN
We are seeking someone who possess extensive knowledge and has experience in all aspects of the credentialing, re-credentialing and privileging processes. This position is responsible for ensuring providers are credentialed, appointed, and privileged with health plans.
We are seeking someone who possess knowledge and has experience in all aspects of the credentialing, re-credentialing and privileging processes. This position is responsible for ensuring providers are credentialed, appointed, and privileged with health plans. Must have "payor enrollment" experience.
**Familiarity with CAQH and PECOS is a must.
EnduraCare fosters a TEAM environment with a strong culture built on integrity and work ethic.
EnduraCare Acute Care Services, founded in 1981, is the nation''s largest privately-held provider of therapy program management for hospitals and free-standing outpatient clinics. We are headquartered in Franklin, Tennessee and operating in more than 14 states. We deliver labor productivity, revenue growth, staffing solutions, educational resources, and rehab expertise to ensure optimal performance. We are experts at and understand the complex reimbursement structures across all venues. We do one thing, and we do it well! To learn more, visit our website: www.enduracareac.com
ABOUT THIS ROLE
To be successful in this role, the candidate must be a ''people person'', have a jovial personality, be extremely flexible, innovative and team oriented; This position requires strict adherence to confidentiality and the maintenance of confidential documents / information.
Essential Duties and Responsibilities
The position is responsible for all aspects of the credentialing, re-credentialing and privileging processes for Rehabilitation Therapists who provide patient care. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
- Compiles and maintains current and accurate data for all providers.
- Completes provider credentialing and re-credentialing applications; monitors applications
- and follows-up as needed.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and
- any other required credentialing documents for all providers.
- Maintains corporate provider contract files.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Sets up and maintains provider information in online credentialing databases and system.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Ensures practice addresses are current with health plans, agencies and other entities.
- Tracks license, DEA and professional liability expirations for appointed Health providers.
- Audits health plan directories for current and accurate provider information.
- Submit closed files for audit/final review and secure missing items as identified by audit/final review
- Monitor collection of all information received; follow up on missing items and/or incomplete forms
- Knowledge and understanding of the Outpatient Rehab Therapy credentialing process.
- Ability to organize and prioritize work and manage multiple priorities.
- Excellent verbal and written communication skills including, letters, memos and emails.
- Excellent attention to detail.
- Ability to research and analyze data.
- Ability to work independently with minimal supervision.
- Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
- Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
- 1 year experience in healthcare credentialing preferred
- Associate degree or an equivalent combination of education and experience required
- Bachelor degree preferred
- Experience with credentialing accreditation by Joint Commission or National Committee for Quality Assurance preferred
Submit Resume to:
Director of Recruiting