Credentialing Enrollment Specialist
Core
Oversees internal processes and regulatory requirements for the timely and accurate completion and submission of provider applications for managed care organizations.
Role type
Credentialing and enrollment specialist
Builds
Provider enrollment and credentialing files for managed care organizations (MCOs)
Domain
Healthcare administration / Managed care
Deliverable
client delivery
Required skills
Primary source verification, data entry, practice site visits, file preparation for audits, issue resolution, regulatory compliance knowledge
Preferred skills
NAMSS CPCS or CPMSM certification, Bachelor's degree
Technologies
ECHO database, Windows, Microsoft applications, multi-line telephone
Responsibilities
Perform primary source verifications of documentation for provider credentialing; Enter provider data in the ECHO database; Conduct practice site visits; Prepare physician files for audits; Provide issue resolution regarding billing and enrollment; Review provider directories produced by MCOs.