Provider Payer Enrollment Credentialing Administrator

Overview

This is a hybrid role in office on Tuesday-Thursday and working from home on Monday and Friday. Community Medical Services (CMS) is hiring a Credentialing Administrator. Under the supervision of the Credentialing Admin Supervisor, the Credentialing Administrator is responsible for maintaining credentialing records, files and reports for all staffed physicians, nurses, licensed counselors and all CMS facilities. This role will also prepare and submit required credentialing applications and primary source documents to state, federal and Health Maintenance Organizations for initial and reappointment credentialing and payer enrollment for providers and facilities.

This candidate will work collaboratively with several cross-functional teams in our fast-paced, deadline-driven environment.

As part of our mission to help individuals recover from substance use disorders, you’ll thrive in a supportive, engaging, and fulfilling work environment where your contributions are valued.

• Subsidized medical, dental, and vision insurance
• Health savings account
• Short and long-term disability insurance
• Life insurance
• Paid sick, vacation, and holiday time
• 401K retirement plan with match
• Tuition and CME reimbursement up to 100%
• Employee assistance program to support your mental health and wellness
• Ongoing professional development

• Compiles and processes provider documents to submit applications for payer and facility enrollment in compliance with federal, state, managed care, and regional requirements.
• Maintains provider data to monitor applicant progress in the credentialing/enrollment/recredentialing process with Federal, State and Managed Care organizations.
• Ensures consistent documentation and complete verification of provider credentials.
• Coordinates data collection from cross functional teams to be included in the credentialing files. Monitors the recruitment status of provider staff candidates to ensure timely credentialing submissions to State Medicaid Agencies, Medicare and HMOs.
• Maintains credential and peer review files, e.g. keeps all licensure, certifications, etc. current.
• Loads all applicable rendering providers into CMS Electronic Medical Record System and Electronic Health Record System.
• Has utilized the following databases to manage the providers enrollments:
  Pecos, I&A, NPPES, APEP, CAQH and Availity.
• Able to navigate each of the health plans websites to submit payor enrollments or provider and facility enrollments (i.e., Medicare, State Medicaid/AHCCCS, UHC/Optum, BCBS, Cigna, Humana and Aetna).
• Medicare and Medicare revalidations according to each state level.
• Identifies issues that require additional investigation and evaluation; validates discrepancies and ensures appropriate follow ups.
• Interface with state and federal agencies such as Medicare, Commercial and Medicaid Health plans, providers, facility, licensing agencies on a regular basis.
• Uses critical thinking to conduct follow-up with individual practitioners internal and external entities to resolve discrepancies identified during the credentialing process.

• Requires an education level of at least a high school diploma or GED. An Associate or Bachelor degree is preferred.
• At least 3 years healthcare credentialing and enrollment experience is required.
• Basic familiarity with healthcare / medical industry is required.
• Computer skills to include PDF, Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
• Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

• The ability to use a phone, computer, printer, and copier is required.
• Frequent use of Microsoft Office products, including Outlook, Word, Excel, and PowerPoint.
• The ability to use the internet and various web browser software is required.

• Requires sitting and standing associated with a normal office environment.
• Manual dexterity using a calculator and computer keyboard.
• Require…