Medusind Solutions
From Medusind Solutions's careers page
Status: listed on the employer's own careers page when we last checked (daily). Confirm on their site before applying.
Under the direction of the Provider & Enrollment and Contracts Manger, the Credentialing & Enrollment Representative evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing processes of clinical providers (Medical, Dental, Optometry and Behavior Health) and clinics with participating health insurance plans.
Enroll with health plans using accurate and detail orientation to be able to complete health plan enrollment applications and submit enrollment to payors in a timely manner
Deep understanding of health plans including CAQH, Medicare, Medicaid, Managed Care and Commercial Plans
Determine re-credentialing dates and complete re-credentialing of all providers and clinics(groups) with appropriate health plans
Maintain all enrollment data and follow ups with health plans in centralized spreadsheets for each client
Possess knowledge and ensure CAQH are created, updated on a quarterly basis
Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures
Ensure all provider demographic information as well as NPPES is kept up to date at all times
Participate in agenda prep meetings as well as client calls at all times
Electronically prepare and track, and follow-up on appropriate verifications for efficient, high-volume processing of individual provider applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines
Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies
Identifies, analyzes and resolves extraordinary information or discrepancies that could adversely impact ability to credential and enroll practitioners
Be prepared to provide feedback and give updates pertaining to credentialing and health plan enrollment for providers and clinics
Communicates clearly with providers, their liaisons, medical staff leadership and Administration, as needed to provide timely responses
Communicate regularly with your colleagues, management, health plans and providers at all times
Be available for all internal and client meetings in a timely manner
Be able to take initiative and take a proactive response to all identified issues as opposed to being reactive after something goes wrong
Be able to problem solve and come up with solutions to credentialing problems and report to management when necessary
Be able to think outside the box and identify issues and problems before they happen
Maintain current and accurate records of provider and credentialing provider data, including initial and re-credentialing
Educational Background: Bachelor’s degree in Healthcare Administration, Business, Finance or a related field (preferred)
Experience: A minimum of 2 years of full-time experience in all facers of credentialing, including interactions with healthcare providers. Experienced with Medicare, Medi-Cal, Managed Care and Commercial insurances. Proficient in enrollment terminology
Expert Industry Knowledge: Strong knowledge of Federally qualified health centers (FQHCS) and Community Health Centers (CHCs)
Communication & Collaboration: Strong ability to collaborate with cross-functional teams
Detail-Oriented: High level of accuracy, with the ability to set and maintain priorities in a fast-paced environment
Technical skills: Strong knowledge in the use of Microsoft Excel, Word, and Outlook
Adaptability and flexibility: Should be able to adapt to changes in regulations, technologies, and industry trends and adjust accordingly
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Hi [Name], I just applied for the Credentialing & Enrollment Representative role at Medusind Solutions. My background in [your most relevant experience] lines up well with what the team is looking for. Would you be open to a quick chat, or could you point me to the right person on the team? Thank you!
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