Credentialing Enrollment Specialist

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Advocate Aurora Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $10.2M Grant on 2019-08

Healthcare • Healthcare Insurance

Advocate Aurora Health is a leading healthcare organization that operates across various regions including Central Chicagoland, Central Wisconsin, Greater Milwaukee, and more. With a diverse range of career areas such as advanced practice clinicians, behavioral health, nursing, and more, Advocate Aurora Health is committed to helping people live well. The organization offers numerous benefits and opportunities for career advancement, fostering an environment where individuals can thrive and innovate in the healthcare sector. Advocate Aurora Health prioritizes the safety of its candidates and maintains a robust recruitment process to protect sensitive information.

📋 Description

• Perform primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers • Provide issue resolution and support regarding billing issues related to provider enrollment and credentialing • Enter provider data in the ECHO database according to departmental processes • Provide feedback to System entities on applicant status • Follow up on expired licenses, board certifications, insurance, and DEA registrations • Prepare physician files for audits by managed care organizations, Corporate Compliance, and accreditation entities • Conduct practice site visits for MGD practices • Facilitate timely and accurate information flow to Managed Care Organizations and the System • Review provider directories and other information produced by managed care organizations • Support the CPN Credentialing and Quality Review Committee • Communicate with employees, corporate staff, providers, and external agencies • Travel occasionally to other corporate offices

🎯 Requirements

• High school diploma or GED required • Bachelor's degree preferred • Three years' experience in provider credentialing, privileging, and/or enrollment in a hospital, managed care plan, or CMS environment • Knowledge of and experience with personal computers, Windows, and Microsoft applications • Experience with copier and fax machines and multi-line telephones • Experience in typing, word processing, and business correspondence • CPCS or CPMSM certification preferred • Frequent verbal and written communication in English required • Ability to work Monday through Friday, 8:00 AM to 4:30 PM • Ability to sit for long periods, stand, walk, use repetitive wrist/arm motions, and lift 20–50 pounds • Ability to work under time sensitivity, heavy volumes, and frequent interruptions • Occasional travel to other corporate offices • Personal vehicle required • Intact sense of sight and hearing required

🏖️ Benefits

• Benefits Eligible • Premium pay such as shift, on call, and more based on a teammate's schedule • Incentive pay for select positions • Opportunity for annual increases based on performance • Paid Time Off programs • Medical, dental, vision, life, and Short- and Long-Term Disability benefits • Flexible Spending Accounts for eligible health care and dependent care expenses • Adoption assistance and paid parental leave • Defined contribution retirement plans with employer match • Other financial wellness programs • Educational Assistance Program • Career development programs • Well-being programs