Provider Credentialing and Enrollment Specialist

Job not on LinkedIn

🔥 1 hour ago

🏖️ New Jersey, New York – Remote

🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $33 - $36 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Ohio Chapter, American Academy of Pediatrics (Ohio AAP)

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 1934

📚 Education

⚕️ Healthcare Insurance

🤝 Non-profit

Education • Healthcare Insurance • Non-profit

Ohio Chapter, American Academy of Pediatrics (Ohio AAP) is dedicated to educating and advocating for the health and well-being of children and adolescents in Ohio. The organization offers resources, training, and advocacy actions aimed at improving pediatric care, promoting vaccination, and addressing key health issues in the community. They also facilitate engagement among healthcare providers and families through various educational programs and initiatives focused on child health.

📋 Description

• Review and resolve enrollment with focus on state-specific requirements. • Identify and trend denial patterns to prevent recurrence (e.g., taxonomy mismatches, missing DEA, non-participating providers, admitting privileges). • Review Medicaid applications, revalidations, and facility enrollments at both group and individual levels. • Support NY ETIN and ETINS processing as required. • Prepare and submit monthly rosters and uploads, including new provider additions and terminations. • Manage delegated rosters such as NY-NJ Fidelis and submissions through 3rd party vendor Medallion platform • Track and resolve payors pending over 90 days and identify roadblocks. • Manage incoming emails and correspondence and confirm appropriate mail types and follow-up actions. • Support telehealth enrollment workflows and system integrations. • Ensure requests submitted through 3rd party vendor Medallion are timely and accurate. • Collaborate with leadership to identify root causes of delays and prevent recurrence.

🎯 Requirements

• Experience minimum two years in provider credentialing and enrollment, including Medicaid/revalidations/ETIN certifications for NY/NJ states • Knowledge of CAQH, Application utilizing our 3rd party vendor platform-Medallion • Strong attention to detail and analytical skills. • Ability to manage multiple priorities in a fast-paced environment

🏖️ Benefits

• Competitive salary