Credentialing & Provider Enrollment Specialist (Remote)

Job Description

Credentialing & Provider Enrollment Specialist

(Remote)

Our mission to change wound care and improve the lives of others isn’t easy, but it’s worth it! One in ten residents in a skilled nursing facility will develop a skin condition requiring expert medical care. We believe that every person deserves the very best wound care. Building and leading wound care teams is how we do it! Our wound care providers bring education and encouragement to the people who take care of our patients 24/7. When they get better at their jobs, our patient’s wounds heal faster and that is our goal!

Main Responsibilities (may include but are not limited to):

Facilitate and complete submission of applications to enroll group and individual providers with Medicare, Medicaid, and commercial payers in multiple states (including WA, OR, UT, ID)

Ensure enrollment applications are submitted accurate and timely to payers

Initiate follow up on submitted applications

Respond timely to requests for additional information when prompted by the payers

Responsible for updating our group and provider information both internally within our organization and externally with the payers

Conduct audit verifications in CAQH profiles to ensure validity of data

Maintain and organize all documents necessary for the enrollment process

Utilize tracking system to maintain and organize provider records and submitted enrollment applications

Identify trends to recurring issues or barriers with payers and communicate proactively to management

Other duties as assigned

Skills required to succeed:

2+ years credentialing experience and working with insurance payers is required

2+ years direct knowledge and experience using sites CAQH, PECOS, and NPPES is required

CredentialMyDoc experience preferred, but not required

Strong work ethic, and an extremely high attention to detail with excellent use of critical thinking skills

Excellent organization and use of time management skills

Ability to prioritize work load, and have a strong sense of urgency when time sensitive situations arise

Strong verbal and written communication, as well as customer service skills; must be able to listen and communicate effectively with partner facilities, co-workers, patients, and insurance companies

Knowledge of applicable federal, state and local laws and regulations including the requirements of the HIPAA and OSHA regulations pertinent to medical practices, and must be able to maintain confidentiality

Proficient with computers and navigating within multiple web browsers

Experience navigating common insurance payer provider portals

Proficient in MS Office (specifically Outlook, Excel, Word, and Teams)

Must be punctual, dependable, and able to work independently

Must be trustworthy, honest and have a positive and professional attitude

Compensation: $22.00-$29.00 DOE and location.

This position is classified as: Hourly, Non-Exempt; Full-Time employment

Hours: Typical hours are Monday through Friday; 7:30am – 4:00pm PST, (occasional overtime depending on volume)

Benefits:

Work remotely from a home office

Medical/Dental/Orthodontic/Vison/RX - 80% towards employee monthly premiums covered, HSA matching

Life and Disability Insurance

401(k) match on first 4%

Core Values that promote work-life harmony

Work with amazing people who have created a culture where we recognize each other’s wins and don’t tolerate gossip or drama

Website:

We are a drug-free workplace. All offers of employment are contingent upon a successful drug screen and criminal background check. EEO.

Full-time

Fully remote