Job Functions

Understands and completes all roles in the Credentialing Department related to provider management:

Onboarding

• Working with providers and offices to obtain complete records from new providers
• Verifying data and interpreting results
• Data entry and file setup
• Timely processing and presentation for approval

Enrollment

• Completing third party applications for payers, facilities, malpractice insurance, etc.
• Working effectively and professionally with providers and contacts to follow the process through approval

Maintenance

• Keeping providers records up to date and current with internal standards
• Responding to payer and facility requests for re-processing applications on schedule
• Running reports on all credentials/expirables such as licenses, DEA’s, CPR certificates, etc. and maintaining current copies
• Reporting continue education credits to CE Broker
• Educating providers and offices on processes and assisting in issue resolution
• Intake and appropriate processing of requests from all external and internal parties
• Responding and assisting in the resolution of billing and claims issues
• Making sure external sources are updated regularly such as CAQH, NPI, etc.

Establishes and maintains a strong working relationship with company staff, providers, third-party payers, and all other entities.

Participates in delegated credentialing activities as may differ from the above tasks

Supports the Credentialing Department with special projects as needed

Other duties as assigned by Manager

Abilities Required

• Minimum 3 years’ experience in the credentialing field
• CPCS (Certified Provider Credentialing Specialist) preferred
• Proficient with Microsoft Applications (Word, Excel, Outlook) and Windows
• Strong data entry skills
• Professional written and spoken communication skills
• Working knowledge of Credential My Doc Software (will be taught)
• High level of attention to detail
• Ability to handle multiple documents pertaining to several providers at once
• Applying complex, detailed guidelines in the preparation and review of all applications to ensure compliance with CMS, state regulations, NCQA and internal procedures and protocols
• Excellent time management skills to handle multiple tasks simultaneously
• Demonstrated ability to work independently and prioritize work
• Team orientation & flexibility in accepting change

AAP/EEO Statement
In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Elevate ENT will be based on qualifications and job related abilities. Elevate ENT does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, ancestry, sexual orientation, marital status, gender identity or any other characteristic protected by law. Elevate ENT will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in undue hardship.

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