Credentialing & Payer Enrollments Specialist
Together Women's Health, LLC, Grosse Pointe, Michigan, United States, 48236
Overview
Together Women’s Health (TWH) is adding a Credentialing & Payer Enrollments Specialist to be an important member of our accounting team. We are seeking a detail-oriented and experienced Credentialing and Payer Enrollments Specialist to join our healthcare organization. This position is responsible for managing the complete credentialing lifecycle for healthcare providers and ensuring timely enrollment with insurance payers. The ideal candidate will have extensive knowledge of credentialing requirements, payer enrollment processes, and regulatory compliance in the healthcare industry. Responsibilities
The following duties and responsibilities generally reflect the expectations of this job but are not intended to be all inclusive. The essential functions include the most significant tasks and are the essence of why the role exists; removing an essential duty would fundamentally alter the role. Provider Credentialing Initiate and manage the credentialing process for new providers, including physicians, nurse practitioners, physician assistants, and other healthcare professionals Collect, verify, and maintain all required credentialing documentation including licenses, certifications, education verification, work history, malpractice insurance, and references Ensure compliance with state and federal regulations, accreditation standards, and organizational policies Coordinate primary source verification for all credentialing elements Maintain detailed tracking systems and databases for all credentialing activities Prepare and submit credentialing applications to hospitals, health systems, and other healthcare facilities Payer Enrollment Management Complete enrollment applications for providers with commercial insurance plans, Medicare, Medicaid, and other third-party payers Monitor enrollment status and follow up on pending applications Maintain current knowledge of payer-specific enrollment requirements and deadlines Coordinate with providers to obtain necessary documentation and signatures Ensure accurate provider demographic and practice information across all payer systems Manage provider directory updates and changes Maintenance and Re-credentialing Monitor expiration dates for licenses, certifications, malpractice insurance, and other time-sensitive documents Initiate re-credentialing processes in advance of expiration dates Update provider information with payers as needed for address changes, specialty additions, or other modifications Maintain organized filing systems for all credentialing and enrollment documentation Compliance and Quality Assurance Ensure all credentialing activities comply with NCQA, URAC, Joint Commission, and other relevant standards Conduct regular audits of credentialing files to ensure completeness and accuracy Stay current with changing regulations and industry best practices Participate in accreditation surveys and provide necessary documentation Communication and Coordination Serve as primary liaison between providers, payers, and internal stakeholders Provide regular status updates to leadership and providers regarding credentialing progress Resolve credentialing issues and barriers in a timely manner Collaborate with Revenue Cycle Management team to ensure billing capability following enrollment completion Qualifications
REQUIRED EDUCATION, EXPERIENCE, KNOWLEDGE, SKILLS, AND ABILITIES: Minimum 3 years of experience in healthcare credentialing and payer enrollment 2-year college degree with additional training, experience and related certifications is required Proficiency in credentialing software platforms (CAQH ProView, PECOS, state Medicaid portals) Strong computer skills including Microsoft Office Suite, database management, and electronic filing systems Experience with primary source verification processes and requirements Familiarity with NPDB, OIG exclusion lists, and other verification databases Previous experience with credentialing software systems and databases Knowledge of medical terminology and healthcare organizational structures Experience with Athena Healthcare EMR or Modio Health software is a plus Exceptional attention to detail and accuracy Strong organizational and time management abilities Excellent written and verbal communication skills Ability to work independently and manage multiple priorities simultaneously Problem-solving skills and ability to navigate complex regulatory requirements Commitment to maintaining confidentiality and handling sensitive information Qualified Applicants may apply for consideration! More About TWH: Together Women’s Health (TWH) was created to be a leading network of integrated women’s healthcare providers. Our business solutions combine good medicine and a strong infrastructure to continuously improve care across Ob-Gyn and other women’s health centered practices. In partnering with physician groups, TWH manages support services that foster growth for private practices and nourish their ability to provide the best total care to their patients.Recognizing a commonality among clinicians in the evolving women’s health sector, where a lack of scale affects their ability to provide more robust care and diverse services, was the motivation for their connected care model. Together Women’s Health was founded in 2020 as a platform for elevating private obstetrics and gynecology practices to their full potential.Our objective is to empower physicians so that they can better serve their patients. We invest heavily in building and maintaining a culture to be the employer of choice, cultivating a community of providers and resources, which in turn enriches patient experience and strengthens doctor-patient relationships. With the combined leadership of expert physicians, experienced Board of Directors, and strategic financial partner, Shore Capital Partners, TWH puts our medical affiliates at the forefront of innovation in women’s health. OUR MISSION To improve the lives of our healthcare partners and their patients. OUR VALUES Trust
- We operate with integrity each day by doing the next right thing – for the patient and the business. Respect
- It’s not what you say, it’s how you make them feel. We listen and always care. Collaboration
- We are one team with a shared vision of success. No one of us is as effective as all of us. Inspired
- We bring enthusiasm and passion to the workplace. We believe we can achieve anything. Accountability
- We are responsive and keep our promises to our patients, our partners, and one another. Excellence
- We are committed to exceeding expectations and advancing the patient experience in all that we do.
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Together Women’s Health (TWH) is adding a Credentialing & Payer Enrollments Specialist to be an important member of our accounting team. We are seeking a detail-oriented and experienced Credentialing and Payer Enrollments Specialist to join our healthcare organization. This position is responsible for managing the complete credentialing lifecycle for healthcare providers and ensuring timely enrollment with insurance payers. The ideal candidate will have extensive knowledge of credentialing requirements, payer enrollment processes, and regulatory compliance in the healthcare industry. Responsibilities
The following duties and responsibilities generally reflect the expectations of this job but are not intended to be all inclusive. The essential functions include the most significant tasks and are the essence of why the role exists; removing an essential duty would fundamentally alter the role. Provider Credentialing Initiate and manage the credentialing process for new providers, including physicians, nurse practitioners, physician assistants, and other healthcare professionals Collect, verify, and maintain all required credentialing documentation including licenses, certifications, education verification, work history, malpractice insurance, and references Ensure compliance with state and federal regulations, accreditation standards, and organizational policies Coordinate primary source verification for all credentialing elements Maintain detailed tracking systems and databases for all credentialing activities Prepare and submit credentialing applications to hospitals, health systems, and other healthcare facilities Payer Enrollment Management Complete enrollment applications for providers with commercial insurance plans, Medicare, Medicaid, and other third-party payers Monitor enrollment status and follow up on pending applications Maintain current knowledge of payer-specific enrollment requirements and deadlines Coordinate with providers to obtain necessary documentation and signatures Ensure accurate provider demographic and practice information across all payer systems Manage provider directory updates and changes Maintenance and Re-credentialing Monitor expiration dates for licenses, certifications, malpractice insurance, and other time-sensitive documents Initiate re-credentialing processes in advance of expiration dates Update provider information with payers as needed for address changes, specialty additions, or other modifications Maintain organized filing systems for all credentialing and enrollment documentation Compliance and Quality Assurance Ensure all credentialing activities comply with NCQA, URAC, Joint Commission, and other relevant standards Conduct regular audits of credentialing files to ensure completeness and accuracy Stay current with changing regulations and industry best practices Participate in accreditation surveys and provide necessary documentation Communication and Coordination Serve as primary liaison between providers, payers, and internal stakeholders Provide regular status updates to leadership and providers regarding credentialing progress Resolve credentialing issues and barriers in a timely manner Collaborate with Revenue Cycle Management team to ensure billing capability following enrollment completion Qualifications
REQUIRED EDUCATION, EXPERIENCE, KNOWLEDGE, SKILLS, AND ABILITIES: Minimum 3 years of experience in healthcare credentialing and payer enrollment 2-year college degree with additional training, experience and related certifications is required Proficiency in credentialing software platforms (CAQH ProView, PECOS, state Medicaid portals) Strong computer skills including Microsoft Office Suite, database management, and electronic filing systems Experience with primary source verification processes and requirements Familiarity with NPDB, OIG exclusion lists, and other verification databases Previous experience with credentialing software systems and databases Knowledge of medical terminology and healthcare organizational structures Experience with Athena Healthcare EMR or Modio Health software is a plus Exceptional attention to detail and accuracy Strong organizational and time management abilities Excellent written and verbal communication skills Ability to work independently and manage multiple priorities simultaneously Problem-solving skills and ability to navigate complex regulatory requirements Commitment to maintaining confidentiality and handling sensitive information Qualified Applicants may apply for consideration! More About TWH: Together Women’s Health (TWH) was created to be a leading network of integrated women’s healthcare providers. Our business solutions combine good medicine and a strong infrastructure to continuously improve care across Ob-Gyn and other women’s health centered practices. In partnering with physician groups, TWH manages support services that foster growth for private practices and nourish their ability to provide the best total care to their patients.Recognizing a commonality among clinicians in the evolving women’s health sector, where a lack of scale affects their ability to provide more robust care and diverse services, was the motivation for their connected care model. Together Women’s Health was founded in 2020 as a platform for elevating private obstetrics and gynecology practices to their full potential.Our objective is to empower physicians so that they can better serve their patients. We invest heavily in building and maintaining a culture to be the employer of choice, cultivating a community of providers and resources, which in turn enriches patient experience and strengthens doctor-patient relationships. With the combined leadership of expert physicians, experienced Board of Directors, and strategic financial partner, Shore Capital Partners, TWH puts our medical affiliates at the forefront of innovation in women’s health. OUR MISSION To improve the lives of our healthcare partners and their patients. OUR VALUES Trust
- We operate with integrity each day by doing the next right thing – for the patient and the business. Respect
- It’s not what you say, it’s how you make them feel. We listen and always care. Collaboration
- We are one team with a shared vision of success. No one of us is as effective as all of us. Inspired
- We bring enthusiasm and passion to the workplace. We believe we can achieve anything. Accountability
- We are responsive and keep our promises to our patients, our partners, and one another. Excellence
- We are committed to exceeding expectations and advancing the patient experience in all that we do.
#J-18808-Ljbffr