Credentialing Enrollment Specialist

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Lighthouse Autism Center

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-07

Healthcare • Healthcare Insurance

Lighthouse Autism Center is a dedicated facility providing comprehensive therapy services for children with autism. With over a decade of experience, they offer a wide range of personalized, evidence-based therapeutic approaches such as ABA therapy, speech therapy, and school readiness programs. Their compassionate and clinically excellent team aims to unlock each child's unique strengths and potential in a nurturing environment, supporting families in the Midwest. Through innovative models like the Lighthouse Fusion approach, they make a significant difference in the developmental paths of children on the autism spectrum.

📋 Description

• Prepare, submit, and track provider enrollment applications with commercial, Medicaid, TRICARE, and other contracted health plans • Coordinate provider revalidations, reenrollments, and ongoing payer participation requirements • Monitor application status and follow up with payer representatives to resolve delays and outstanding requests • Collaborate with Human Resources, Clinical Operations, Revenue Cycle, and Compliance to ensure providers are enrolled before rendering services • Maintain documentation of applications, approvals, correspondence, and payer confirmations • Research payer-specific enrollment requirements and communicate relevant changes • Respond to inquiries about enrollment status and provider network participation • Assist with onboarding clinic locations, provider additions, and organizational expansion requiring payer enrollment • Improve enrollment workflows and contribute to process documentation and standard operating procedures • Manage payer enrollment timelines to support provider start dates and organizational growth • Resolve application deficiencies, rejected enrollments, and requests for additional documentation • Coordinate ongoing demographic and maintenance updates for approved providers

🎯 Requirements

• Exceptional organizational skills, attention to detail, and commitment to accuracy • Ability to manage multiple provider enrollment, credentialing, and recredentialing applications while meeting deadlines • Strong prioritization and time management skills in a fast-paced environment • Knowledge of provider enrollment, credentialing, and recredentialing requirements across multiple payers and states • Proficiency in Microsoft Office Suite, CAQH, payer portals, and credentialing/enrollment database systems • Experience preparing, submitting, tracking, and following up on provider enrollment and credentialing applications • Strong verbal and written communication skills for interacting with providers, payers, and internal stakeholders • Ability to interpret and apply payer, regulatory, and accreditation requirements • Understanding of confidentiality requirements and ability to handle sensitive information discreetly • Ability to work independently and collaborate with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams • High school diploma or equivalent required • Minimum two years of experience in provider enrollment, credentialing, healthcare administration, or related healthcare support • Experience with Medicaid, government, and commercial payer enrollment and credentialing applications • Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred

🏖️ Benefits

• Full-time employment • Fully remote work arrangement