[Hiring] Credentialing Enrollment Specialist @American Addiction Centers

Role Description

This position oversees the internal processes and procedures as well as governmental and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning, development, and organization.

• Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
• Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
• Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
• Performs follow-up on needed information (expired licenses, board certifications, insurance, and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
• Prepares physician files for file audits by managed care organizations, Corporate Compliance, and accreditation entities.
• Conducts practice site visits for practices within MGD. Facilitates communication tools and/or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
• Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation.
• Provides team member support to the CPN Credentialing and Quality Review Committee.

Qualifications

• High school diploma or GED.
• Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan, or CMS environment.
• Knowledge of and experience with personal computers, Windows, and Microsoft applications, copier and fax machines, and multi-line telephone.
• Experience in typing, word processing, and business correspondence.
• Bachelor's degree (preferred).
• Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) (preferred).

Requirements

• Perform most duties under normal office conditions which may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles 20-50 pounds.
• Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone or other employees.
• Must use frequent and variable body movements during filing and maintaining records.
• Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies.
• Require occasional travel to other corporate offices.
• Intact sense of sight and hearing required.

Benefits

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training.
• Premium pay such as shift, on call, and more based on a teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.
• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.