Provider Relations/Provider Enrollment-Credentialing Specialist/

THIS POSITION IS NOT REMOTE: MUST BE AVAILALBE TO WORK ON-SITE

At BCMS, the Provider Enrollment Specialist ensures that all providers comply with relevant state and federal regulatory associations. This position is responsible for keeping records related to insurance contracts and medical staff credentials. This includes constant contact with staff, insurance companies, and partnering credentialing teams to ensure they have all the necessary documents and are informed of any changes in contracts and policies.

The Provider Relations/Enrollment Specialist is key to a successful credentialing/enrollment process. Along with other credentialing duties, this position is also directly responsible for preparing and submitting applications and supporting documentation to enroll individual physicians and other healthcare providers with payers. The specialist also processes new applications, revalidations, ERN/ERA applications, and updates rosters.

Major Areas of Responsibility:

• Monitor provider/staff credentials and licenses.
• Advise providers on renewal procedures.
• Keep records in licenses, credentials, and insurance contracts.
• Receive and analyze all verified documentation for Providers and execute provider enrollment with carriers.
• Process new enrollments and revalidations, update rosters, and ensure all Providers are linked to their appropriate sites.
• Shares essential updates with key stakeholders and internal teams as necessary in weekly summary reports or other correspondence.
• Collaborate regularly with the Billing team on enrollment issues to investigate and correct.
• Work closely and effectively with Human Resources and Providers.
• Correspond with the credentialing team within all healthcare partnerships, providers, and program directors as necessary to provide constant, up-to-date status as needed.
• Establish a relationship with the carrier credentialing representative and keep up with any changes or updates from the carriers.
• Maintain an organized filing system of all providers' credentialing information in a safe and secure environment to remain in compliance with HIPAA.
• Update Provider's CAQH accounts.
• Work in PECOS and NPPES, as necessary.
• Performs all other duties as assigned.

Education:

• High School Diploma required.
• BS preferred.
• Knowledge of Meditech Expanse a plus.

Work Experience:

• A minimum of 3 years of experience with provider enrollment processing/credentialing experience is required.
• Detailed, oriented, and organized.
• Experience working with insurance carriers and the provider enrollment portals.
• Excellent problem-solving and critical-thinking skills.
• Able to perform with autonomy.
• Excellent communication skills across all levels in the agency.
• Familiarity with NCQA standards and how to apply them.
• Proficient with basic computer systems, networks, and software applications, such as the Microsoft Office Suite (Outlook, Word, and Excel).

Licensure/Certification/Affiliation:

• Certified Provider Credentialing Specialist (CPCS) certification through the National Association of Medical Staff Services (NAMSS) is a plus.

Skills, Knowledge, and Abilities:

• Creative and critical thinking
• Interpersonal skills that establish productive working relationships with a multidisciplinary team and administrative support
• High-level ability to use an electronic medical record.
• Ability to communicate effectively in both written and verbal form to patients, public, medical staff, and physicians.
• Experience working in a diverse environment.

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• AD&D insurance
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• On call

Ability to Relocate:

• Macclenny, FL 32063: Relocate before starting work (Required)

Work Location: In person