[Hiring] Credentialing & Enrollment Analyst I @Family Allergy & Asthma

Role Description

This position offers the flexibility to work either fully onsite or remotely but must reside in any of the following states: AR, FL, IL, IN, KY, MO, OH, PA, or TN.

The Credentialing & Enrollment Analyst I role involves daily management of credentialing & enrollment processes for providers (physician, nurse practitioner & physician assistants) that are employed by Family Allergy MSO. The analyst collaborates directly with the providers, insurance companies, hospitals, and other related healthcare entities to ensure that all necessary documents are maintained accordingly, submitted to the various entities and participation of the provider is approved and/or active. This role ensures providers meet all regulatory and compliance requirements to be reimbursed for services billed to the insurance carriers.

Summary of Duties & Responsibilities:

• Communicate with new provider to obtain documentation necessary for credentialing & provider enrollment processes.
• Create/Update required credentialing/enrollment portals.
• Medical Licensure – ensure active medical licensure respect to provider assigned regions.
• Board certification – ensure active board certification for related provider specialty.
• Malpractice – complete malpractice application, obtain signatures submit to contact.
• CAQH, Availity, CMS Systems – Update with all current accurate related data.
• Provider Enrollment – Insurance Plan Participation; Complete provider enrollment applications.
• Ensure timely follow-up procedures, throughout enrollment process.
• Complete re-credentialing and revalidations requests prior to deadlines, ensure re-approval is achieved.
• Hospital Privileges – Work in step with provider and hospital medical staff office completing application processes.
• Initial privileges – Complete applications for physicians.
• Re-Appointments – Complete reappointment applications.
• Dues and Application fees – Submit requests for payment to accounting via MyStampli system or pay by credit card.
• Excel Spreadsheets – Update various related excel sheets related to assigned providers such as Provider Credentialing; Provider Enrollment Tracker; Onboarding Checklist; Provider Insurance ID/PTAN; Hospital Affiliations; Provider NPI/License/DEA; Government Plan Revalidation; Standard Roster Templates; Current Locations; Malpractice; RCM Claims issues.
• Maintain active list of providers with medical society/board memberships and process related dues/fees yearly.
• Work shared email box with team members and respond or complete requests related to assigned providers.
• Reminder System – Notifications routed to team via HER-Medical Management system. Review daily and complete requests as required.
• RCM – Claims issues - assist in resolving claims issues that are provider enrollment related, which involves communication with the various insurance companies.
• Work notifications from RCM related to Checks from carriers being sent to wrong “pay to” address.
• Special Projects - complete any special assignments requested by Sr. Analyst or Payor Relations Manager.
• Other duties as assigned.

Qualifications

• Effective communication skills to include:
• Ability to fluently speak and read English.
• Ability to read and interpret documents such as safety rules, handbooks, policies, and procedure manuals.
• Ability to communicate effectively, verbally and written, with all levels of staff and patients.
• Required: High School Diploma or equivalent.
• Minimum of 2 - 3+ years of provider initiated “submission” level of provider enrollment and credentialing experience in any of the following states (AR, FL, IL, IN, KY, MO, OH, PA, TN).
• Florida credentialing & provider enrollment application experience preferred.
• Attention to detail and strong organizational skills.
• Knowledge of healthcare regulations & payor enrollment processes.
• Excellent communication skills (oral & written) to coordinate with providers, payers, medical staff offices, and other Family Allergy department team members.
• Proficiency in MS Office (Excel, Word, Outlook, TEAMS) & Adobe (edits, printing, saving, routing).
• Proficiency in various Payor portals (Availity, CAQH).
• Ability to work independently and manage multiple tasks with minimal supervision.
• Basic computer skills and understanding of modern office practices.

Requirements

• The physical demands described, here, are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the physical demands.
• While performing the duties of this job, the employee is regularly required to use hands to handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.
• The employee frequently is required to stand, walk, stoop, kneel, crouch, reach, push, pull, bend and sit. On average, injection room or clinic staff may be standing or walking 80% of their shift.
• The employee must occasionally lift and/or move up to 30 pounds.
• Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
• Specific communication abilities required by this job include the ability to talk and hear in order to converse with others, discern, convey, express oneself, and exchange information.

Benefits

• All Family Allergy & Asthma divisions are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.
• Family Allergy & Asthma divisions are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
• We believe that diversity and inclusion among our teammates is critical to our success.