Credentialing Enrollment Specialist
Company: Atrium Health
Location: Charlotte
Posted on: April 16, 2024
Job Description:
Overview Job Summary Oversees the internal processes and
procedures as well as Governmental, and regulatory requirements for
the timely and accurate completion and submission of provider
applications. Assists in departmental planning, development, and
organization. Essential Functions
- Performs primary source verifications of documentation required
for managed care credentialing and re-credentialing of MGD
providers.
- Provides issue resolution and support regarding billing issues
as they relate to provider enrollment and credentialing for MGD
providers and the Central Billing Office.
- Enters provider data in the ECHO database according to
established departmental processes and provides feedback to other
System entities as to the status of the applicants.
- Performs follow-up on needed information (expired licenses,
board certifications insurance and DEA registrations) on an ongoing
basis and ensures receipt of same in a timely manner.
- Prepares physician files for file audits by managed care
organizations, Corporate Compliance and accreditation
entities.
- Conducts practice site visits for practices within MGD.
Facilitates communication tools and or activities to maintain
timely and accurate flow of information to Managed Care
Organizations (MCOs) and the System.
- Reviews hard copy and electronic provider directories and other
information produced by managed care organizations reflecting MGD
and the System's demographics and participation.
- Provides Team member support to the CPN Credentialing and
Quality Review Committee. Physical Requirements Perform most duties
under normal office conditions which may include sitting for long
periods of time, standing, walking, using repetitive wrist/arm
motion or lifting articles 20-50 pounds. Work is subject to time
sensitivity, heavy volumes, and frequent interruptions, either by
phone or other employees. Must use frequent and variable body
movements during filing and maintaining records. Require frequent
verbal and written communication in English to employees, corporate
staff, providers, and external agencies. Require occasional travel
to other corporate offices. Use of personal vehicle required.
Intact sense of sight and hearing required. Education, Experience
and Certifications
High school diploma or GED required; Bachelor's degree preferred.
Three years' experience in a role that performs or supports
provider credentialing, privileging, and/or enrollment in either a
hospital, managed care plan or CMS environment is required.
Knowledge of and experience with personal computers, Windows and
Microsoft applications, copier and fax machines and multi-line
telephone required. Experience in typing, word processing, and
business correspondence is required. Certification through National
Association of Medical Staff Services (NAMSS) as Certified Provider
Credential Specialist (CPCS) or Professional Medical Services
Management (CPMSM) preferred.
Keywords: Atrium Health, Gastonia , Credentialing Enrollment Specialist, Other , Charlotte, North Carolina
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