Credentialing and Enrollment Representative

🕒 September 4

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 43%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Medusind

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

📦 Logistics

🏭 Manufacturing

💰 Debt financing on 2023-05

Consulting • Logistics • Manufacturing

Medusind is a healthcare revenue cycle management (RCM) and business process outsourcing company that provides end-to-end and point solutions for medical and dental providers. It offers medical and dental billing, coding, credentialing, accounts receivable and denial management, supply chain and accounts payable services, plus proprietary SaaS products (MedClarity, Dental QuickVerify) and analytics to improve collections and operational efficiency. Medusind serves physician groups, hospitals, FQHCs, behavioral health facilities, dental practices and DSOs, emphasizing technology-driven, scalable services and automation to maximize provider revenue.

📋 Description

• Evaluate, analyze, and coordinate credentialing and recredentialing processes for clinical providers and clinics with participating health insurance plans • Complete and submit health plan enrollment applications to payors in a timely manner • Determine recredentialing dates and complete recredentialing for providers and clinics with appropriate health plans • Maintain enrollment data and follow-ups with health plans in centralized client spreadsheets • Create and update CAQH records quarterly • Enter, update, and maintain provider application data in the credentialing database • Keep provider demographic information and NPPES current • Participate in agenda preparation meetings and client calls • Prepare, track, and follow up on verifications for high-volume provider applications • Monitor files for completeness, accuracy, quality standards, accreditation requirements, and policy compliance • Identify, analyze, and resolve discrepancies affecting credentialing and enrollment • Provide feedback and updates on credentialing and health plan enrollment • Communicate with providers, liaisons, medical staff leadership, Administration, colleagues, management, and health plans • Attend internal and client meetings • Proactively identify issues, solve credentialing problems, and report to management when necessary • Maintain current and accurate provider and credentialing data

🎯 Requirements

• A minimum of 2 years of full-time experience in all facets of credentialing, including interactions with healthcare providers • Experience with Medicare, Medi-Cal, Managed Care and Commercial insurances • Proficient in enrollment terminology • Strong knowledge of Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) • Strong ability to collaborate with cross-functional teams • High level of accuracy, with the ability to set and maintain priorities in a fast-paced environment • Strong knowledge in the use of Microsoft Excel, Word, and Outlook • Ability to adapt to changes in regulations, technologies, and industry trends • Bachelor's degree in Healthcare Administration, Business, Finance or a related field (preferred)

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