Overview
Quadris Team, LLC - A Revenue Cycle Management Group, is searching for a dynamic person to join our Physician Excellence team as a Provider Enrollment Specialist. We are a 100% remote team supporting our Physician clients across the United States. See us at www.quadristeam.com.
Job Focus The experienced Provider Enrollment-Credentialing Specialist will perform facility and health plan credentialing for Physicians, Nurse Practitioners and PAs and work independently to coordinate, develop, monitor, and maintain the credentialing process. This position is responsible for assessing current credentialing status of all employed and independently contracted providers, completing facility and payer applications as needed, and working with leadership to ensure all provider credentialing is properly managed.
The Credentialing Specialist will be responsible for all aspects of the credentialing, recredentialing, and privileging processes for all medical providers who provide patient care, clinics, and facilities. The Specialist will ensure providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities and maintain up-to-date data for each provider in credentialing databases and online systems.
Enrollments with various payors and insurance companies (initial, recredentialing, and change of information), maintaining accounts CAQH, Availity, PECOS, Medicaid; researching errors in credentialing that affect claims; assisting with facility privileging; adding new product lines/addendums to established insurance contracts and establishing new contracts as needed. All tasks are both group and individual enrollments.
Primary - Essential Expectations for Success
Responsible for implementation and oversight of all activities related to payer enrollment for providers.
Responsible for development of payer enrollment policies and procedures.
Maintains knowledge of facility and payer credentialing requirements.
Prepares reports from credentialing database and provides communication regarding credentialing status.
Coordinates and manages the dissemination to health plans and other payers.
Other tasks / projects as assigned by leadership.
Primary Focused Work
PECOS/Medicare Enrollments
Engage with Physician Clients
Provider Licensing
Preferred CPES or CPCS Certification through NAMSS National Professional Organization
Maintaining / Updating Provider Profiles CAQH/NPPES
Facility Enrollment
Multistate Payer Enrollment all Payers
Trends / tracking and maintaining database
Skills Needed to Be Successful
Maintains compliance with regulations and laws applicable to job
Professional level communication expectations with video, phone and email
Ability to effectively prioritize the work to meet deadlines and expectations
Meets the quality and productivity measures as outlined by Quadris
Brings positive energy to the work
Uses critical thinking skills
Being present at work and reducing distractions
Being a self-starter
Incredible attention to detail
Core Talent Essentials
High School diploma or equivalent
2+ years previous experience in healthcare Payer Enrollment and Credentialing
Proven experience credentialing MDs, DOs, NPs & PAs directly with Medicare, Medicaid, Commercial health plans and other private insurance companies to increase revenue
Ability to work independently and within a team atmosphere
Prefer working proficiency of CPT and ICD-10, and general knowledge of healthcare Revenue Cycle Mgmt
Self-motivated and passionate about our mission and values of quality work
Must have professional level skills in MS products such as Excel, Word, Power Point
Must be able to type proficiently and with an effective pace
Proficient application of business/office standard processes and technical applications
Physical Environment
Prolonged periods of sitting at a desk and working from a computer
Must be able to lift 15 pounds at one time
Must be able to structure your home office to ensure patient information is secure, meeting the regulatory expectations
Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.
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Job Focus The experienced Provider Enrollment-Credentialing Specialist will perform facility and health plan credentialing for Physicians, Nurse Practitioners and PAs and work independently to coordinate, develop, monitor, and maintain the credentialing process. This position is responsible for assessing current credentialing status of all employed and independently contracted providers, completing facility and payer applications as needed, and working with leadership to ensure all provider credentialing is properly managed.
The Credentialing Specialist will be responsible for all aspects of the credentialing, recredentialing, and privileging processes for all medical providers who provide patient care, clinics, and facilities. The Specialist will ensure providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities and maintain up-to-date data for each provider in credentialing databases and online systems.
Enrollments with various payors and insurance companies (initial, recredentialing, and change of information), maintaining accounts CAQH, Availity, PECOS, Medicaid; researching errors in credentialing that affect claims; assisting with facility privileging; adding new product lines/addendums to established insurance contracts and establishing new contracts as needed. All tasks are both group and individual enrollments.
Primary - Essential Expectations for Success
Responsible for implementation and oversight of all activities related to payer enrollment for providers.
Responsible for development of payer enrollment policies and procedures.
Maintains knowledge of facility and payer credentialing requirements.
Prepares reports from credentialing database and provides communication regarding credentialing status.
Coordinates and manages the dissemination to health plans and other payers.
Other tasks / projects as assigned by leadership.
Primary Focused Work
PECOS/Medicare Enrollments
Engage with Physician Clients
Provider Licensing
Preferred CPES or CPCS Certification through NAMSS National Professional Organization
Maintaining / Updating Provider Profiles CAQH/NPPES
Facility Enrollment
Multistate Payer Enrollment all Payers
Trends / tracking and maintaining database
Skills Needed to Be Successful
Maintains compliance with regulations and laws applicable to job
Professional level communication expectations with video, phone and email
Ability to effectively prioritize the work to meet deadlines and expectations
Meets the quality and productivity measures as outlined by Quadris
Brings positive energy to the work
Uses critical thinking skills
Being present at work and reducing distractions
Being a self-starter
Incredible attention to detail
Core Talent Essentials
High School diploma or equivalent
2+ years previous experience in healthcare Payer Enrollment and Credentialing
Proven experience credentialing MDs, DOs, NPs & PAs directly with Medicare, Medicaid, Commercial health plans and other private insurance companies to increase revenue
Ability to work independently and within a team atmosphere
Prefer working proficiency of CPT and ICD-10, and general knowledge of healthcare Revenue Cycle Mgmt
Self-motivated and passionate about our mission and values of quality work
Must have professional level skills in MS products such as Excel, Word, Power Point
Must be able to type proficiently and with an effective pace
Proficient application of business/office standard processes and technical applications
Physical Environment
Prolonged periods of sitting at a desk and working from a computer
Must be able to lift 15 pounds at one time
Must be able to structure your home office to ensure patient information is secure, meeting the regulatory expectations
Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.
#J-18808-Ljbffr