Credentialing & Enrollment Specialist - Medusind
Sacramento, CA 95834
About the Job
At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.
Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.
Benefits:
- Health insurance.
- Dental insurance.
- Employer-paid life insurance.
- Employer-paid short-term & long-term disability.
- Voluntary additional life insurance.
- Employee Assistance Program.
- 48 hours of sick time after three months.
- 80 hours of vacation time after six months.
- $400 referral bonus.
Under the direction of the Provider & Enrollment and Contracts Department, The Credentialing & Enrollment Specialist evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing processes of clinical providers (Medical, Dental, Optometry and Behavior Health) and clinics with participating health insurance plans.
Essential Duties & Responsibilities:
- Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
- Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
- Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual provider applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
- Identifies, analyzes and resolves extraordinary information or discrepancies that could adversely impact ability to credential and enroll practitioners.
- Communicates clearly with providers, their liaisons, medical staff leadership and Administration, as needed to provide timely responses.
- Maintain current and accurate records of provider and credentialing provider data, including initial and re-credentialing.
- Possess knowledge of how to enroll with health plans using accurate and detail orientation to be able to complete health plan enrollment applications and submit enrollment to payors in a timely manner.
- Possess knowledge of health plans including CAQH, Medicare, Medicaid, Managed Care and Commercial Plans.
- Possess knowledge of and ensure CAQH are created, updated on a quarterly basis.
Requirement:
- A minimum of 2 years of full-time experience in all facets of credentialing, including interactions with healthcare providers.
- Proficient in enrollment terminology.
- Experienced with Medicare, Medi- Cal, Managed Care and Commercial insurances.
- High preferred background in Federally Qualified Health Centers (FQHCS) and Community Health Centers (CHCs).
- Effective verbal and written communication.
- Excellent attention to detail, accuracy, and a high-level of organizational skills.
- Demonstrate the ability to perform tasks involving independent judgement.
- Must have knowledge in the use of Microsoft Excel, Word, and Outlook.
About Medusind:
Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape.Medusind’s unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations. Client satisfaction is the primary focus of the Medusind leadership and staff.Our highly experienced personnel, cutting edge technology, and forward thinking approach allows us to deliver effective solutions while staying ahead of healthcare industry changes.
Source : Medusind