Job Description

Job Description

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 accurately 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 of 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 with extremely high attention to detail and excellent use of critical thinking skills
• Excellent organization and use of time management skills
• Ability to prioritize workload 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
• Associates working 20+hrs per week:
  1. Medical/Dental/Orthodontic/Vison/RX – minimum 80% towards employee monthly premiums covered, dependent coverage available at employee’s expense
  2. Employer Sponsored Life, AD&D, and Disability Insurance
  3. Voluntary Supplemental Insurance: Accident, Cancer, Critical Illness, STD, Life, Identity Protection, Financial Wellness, and Legal Plan coverages available
• Paid Time Off:
  1. PTO accruals up to 132hrs your first year of employment based on FTE status
  2. 8 paid Holidays for full-time employees
• 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:

*Do you want to grow personally and professionally by working with the best? We’d love to hear from you! Apply now:

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

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