Payor Credentialing And Enrollment Specialist

Payor Credentialing And Enrollment Specialist

A Brief Overview

The Payor Credentialing and Enrollment Specialist will accomplish the following functions for billable employed physicians, allied health professionals or contracted providers associated with UT Regional One Physicians.

What you will do

• Initiate and maintain ROH hospital credentialing for all providers in the group.
• Initiate and maintain payor enrollment for providers.
• Facilitate other hospital and/or facility membership for group providers as indicated.
• Prepare initial credentialing and recredentialing files to be presented to the Credentialing Committee in a timely and expeditious manner.
• Initiate and maintain provider payor enrollment as assigned.
• Ensure accuracy and completeness of provider applications whether paper or electronic.
• Complete and maintain CAQH profile for all assigned billable providers including re-attestation every 90 days.
• Provide regular updates to the payors of changes in billable provider demographics, practice locations, name changes, etc.
• Prepare reports of provider data for distribution to internal and external customers.
• Monitor expirables including license, DEA, board certification, and malpractice and provide current copies to all payors at the time of renewal.
• Maintain accurate and concurrent updates and tracking for each provider to reflect the history of a provider’s credentialing and enrollment status.
• Resolve complex issues relating to provider credentialing.
• Respond to requests by external and internal entities regarding issues pertaining to the status of credentialing and/or enrollment of providers.
• Accurately completes applicable facility (hospital, surgical centers, etc.) applications for signature by affected provider.
• Follow up with facility routinely to ensure information is complete and accurate and that the facility is aggressively processing the application.
• Prepare facility recredentialing applications on all assigned providers.

Qualifications

• Bachelor's Degree Preferred
• Minimum 3 years experience in a healthcare environment with direct related credentialing or payor enrollment experience Required

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Regional One Health is an equal opportunity employer.

• Medical insurance
• Vision insurance
• 401(k)
• Tuition assistance
• Disability insurance

Apply BELOW