Credentialing & Enrollment Specialist

Overview

Job Summary

The Credentialing and Enrollment Specialist will help our communities thrive by supporting operations in owning contracting, provider credentialing, enrollment, and roster management for Catalyst Physician Group and the Catalyst network. We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and providers while growing at an accelerated rate. Every day, we support the health journey of patients by authentically living our core values:
Purpose Driven, Relationships Matter, Serve Others First, and Inspire Creativity. If you love serving others and would like to make a material difference in an industry-transforming organization, then we invite you to apply to this role. We are recognized as one of the Top 100 Places to Work by The Dallas Morning News, and we have been awarded as one of the fastest-growing privately held companies by SMU Cox.

Accountabilities

The Provider Credentialing and Enrollment Specialist, reports to the Manager of Provider Enrollment Services, and is responsible for contracting and onboarding new providers and practices, credentialing and enrolling for applicable Commercial and Medicare plans, roster management for assigned payers and practices, CRM record management, and payer and practice relations. This includes facilitating payer and practice communication, new payer/plan implementations, and claims resolution functions.

Role and Responsibilities:

• Coordinates and owns the new practice or provider onboarding process to ensure timely activation to payer contracts
• Communicates proactively with practices to obtain key credentialing and enrollment data for delegation and payer contracts
• Reviews provider credentialing and enrollment documents returned from the practices for accuracy
• Reconciles and manages network provider rosters to ensure accurate, timely data is provided to payers per network contract requirements
• Facilitates and ensures resolution of network provider issues related to payers including but not limited to contracting, network and panel status, billing and claims, and attribution in a timely fashion
• Prepares agendas, facilitates meetings, and maintains issue tracker for practice and payer meetings
• Maintains network members records, documentation and statuses, as it relates to delegation, payer contracts, onboarding documents
• Collaborates with Growth, Performance Advocate and Accounting teams to provide an excellent membership experience for network participants
• Supports Performance Advocate team and/or practice with operational items such as reporting, communication, and coordination
• Manages payer delegation processes to meet contract timelines and requirements
• Performs ad hoc and root-cause analysis as directed by management
• Maintains network service and credentialing inbox for correspondence
• Completes record audit and maintenance for assigned practices and payers

Minimum Qualifications and Requirements

• Associate degree or equivalent work experience (Bachelor's degree a plus)
• 1+ years' experience in a physician's office or 3+ years related experience in health care environment serving in a credentialing or enrollment role
• Strong communication skills, both written and verbal
• Basic Microsoft Office applications experience
• Value people; demonstrate professional respect and innovative mindset
• Team focus – working in a collaborative environment
• Confident in working with health care professionals and insurance payers
• Passionate about your work and move forward with purpose
• Ability to problem solve when the answer is not clear
• Ability to present issues to providers/clients with proposed solutions
• Data entry experience and documentation skills
• Roster management experience
• Medical Terminology knowledge
• Insurance carrier knowledge

Preferred Experience

• Computer and Microsoft Office applications proficiency
• Advanced Excel Skills
• athena
  
  One platform experience
• Large scale project management skills
• Docusign experience
• Data Analysis