Provider Enrollment, Credentialing Specialist

Job not on LinkedIn

🔥 2 hours ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $19 - $23 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Provider Enrollment Specialist

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Medic Management Group

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🤝 B2B

Healthcare • Consulting • B2B

Medic Management Group is a company whose name indicates it provides management, administrative, or advisory services related to medical or healthcare operations. Public information supplied was limited (LinkedIn cookie/login content only), so this description is deliberately cautious: based on the name it likely supports healthcare providers, facilities, or programs with management, operational support, billing/administrative services, or consultancy rather than being a direct-care provider. Further public details would be needed to specify exact services or business model.

📋 Description

• Credentialing new and established health care providers • Maintenance of information including application completion, follow up, data collection, data entry, and document review • Establish and maintain data entry in CAQH • Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner • Verify provider and group information with insurance companies • Coordinate information for enrollment and terminations of all providers • Maintain good rapport and professional communication with Health Plan Representatives • Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states • Build strong working relationships with medical facilities and provider offices • Adhere to department policies and procedures including timely delivery of completed work and use of resources • Responsible for entering, updating, maintaining NPI and any other applicable provider numbers • Provide concise, timely communication to appropriate leadership regarding potential credentialing issues • Proactively share knowledge with colleagues • Perform analysis and appropriate follow-up of each initial application and reappointment • Work with physicians, professional staff and physician's office staff to acquire necessary materials and information

🎯 Requirements

• High school diploma or equivalent • Minimum 3 years of credentialing experience • Billing knowledge and experience preferred • Prior experience with FQHC and Behavioral Health necessary • Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances • Working knowledge of Availity, PECOS, etc. is required • Proficiency in MS Office, primarily Word, Outlook, Excel • Excellent interpersonal skills to communicate with medical staff, providers and clients • Detail orientation • Ability to abide by HIPPA standards and requirements • Ability to multi-task • Ability to work as a team player • Ability to handle confidential information in a professional manner • Willingness to take on new tasks and responsibilities • Capable of taking the initiative to accomplish tasks • Strong time management and organization skills • Excellent problem solving and decision-making abilities