Credentialing & Enrollment Representative

🔥 19 hours ago

🏄 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 10%

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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

• Enroll providers with health plans by completing and submitting accurate enrollment applications to payors in a timely manner • Understand and manage health plans including CAQH, Medicare, Medicaid, Managed Care, and Commercial Plans • Determine re-credentialing dates and complete re-credentialing for providers and clinics • 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 records up to date • Prepare agendas and participate in client calls and internal meetings • 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 • Proactively identify issues, solve credentialing problems, and report issues to management • Maintain current and accurate provider and credentialing data for initial and re-credentialing

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance or a related field (preferred) • 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 • Proficiency 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 and ability to set and maintain priorities in a fast-paced environment • Strong knowledge of Microsoft Excel, Word, and Outlook • Ability to adapt to changes in regulations, technologies, and industry trends