Clinic Management Services
Job Description: Provider Enrollment & Credentialing Specialist
Position Summary
We are seeking a detail-oriented and proactive Provider Enrollment & Credentialing Specialist to join our professional clinic team. This role is responsible for managing the enrollment and credentialing processes for healthcare providers, ensuring compliance with regulatory standards and payer requirements. The ideal candidate will have strong organizational skills, excellent communication abilities, and a thorough understanding of healthcare operations.
Key Responsibilities
- Stay current with insurance forms, portals and changes for enrollment.
- Complete and submit enrollment applications to Medicare, Medicaid, and commercial payers.
- Track application status and follow up to ensure timely approvals.
- Maintain accurate records of enrollment documents and timelines.
- Credentialing & Re-Credentialing
- Collect, verify, and maintain provider documentation (licenses, certifications, malpractice insurance, etc.).
- Conduct primary source verification and background checks.
- Manage re-credentialing schedules and ensure timely renewals.
- Compliance & Quality Assurance
- Ensure all credentialing activities comply with NCQA, CMS, and payer-specific standards.
- Monitor expirations and proactively update provider files.
- Assist with audits and provide documentation as needed.
Communication, Coordination & Organization
- Serve as liaison between providers, payers, and internal departments.
- Respond to inquiries regarding credentialing status and requirements.
- Educate providers and staff on enrollment processes and timelines.
- Data Management
- Maintain provider profiles in credentialing software and databases.
- Ensure confidentiality and security of sensitive provider information.
Minimum Qualifications
- High School Diploma
- Proficiency in Microsoft Office (Excel, Word & Outlook), Adobe PDF
- Excellent attention to detail, time management, and communication skills.
- General Basic computer skills
- Ability to manage multiple priorities in a fast-paced environment.
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