Credentialing Specialist – Enrollment
Location: HealthPoint Administration
Employment Type: Full-time; 40hrs/week
Would you like to have a career that makes a daily difference in people’s lives? Do you want to be part of a caring, respectful, diverse community? If you answered yes to these questions, keep reading!
HealthPoint is a community-based, community-supported and community-governed network of non-profit health centers dedicated to providing expert, high-quality care to all who need it, regardless of circumstances. Founded in 1971, we believe that the quality of your health care should not depend on how much money you make, what language you speak or what your health is, because everyone deserves great care.
Responsible for the oversight and execution of the enrollment/re-enrollment process with governmental and insurance payer agencies for all HealthPoint licensed, registered, or certified staff. Ensures that all processes meet government and payer requirements. Collaborates with and serves as backup to Credentialing Specialist – Internal.
Your contribution to the team includes:
- Responsible for the day-to-day activities related to processing enrollment/re-enrollment applications for providers and HealthPoint clinics to payer partners.
- Ensure initial enrollment applications and renewals are submitted in a timely and accurate fashion
- Maintain complete and accurate provider enrollment files in MD-Staff credentialing software system
- Maintain accurate and current tracking system for initial and re-enrollments
- Develop relationships with HealthPoint providers, assisting them in completing required tasks and in understanding the credentialing and enrollment process. Work collaboratively with other departments within the organization to maintain communication and complete credentialing tasks efficiently.
- Represent HealthPoint in the credentialing/privileging process with government agencies and health plan credentialing departments and maintain positive working relationships. Ensure HealthPoint enrollment is in compliance with agencies and partner organizations.
- Assist Credentialing Manager to prepare, update and modify policies, procedures and processes that relate to insurance enrollment
- Assist Credentialing Manager in establishing and maintaining delegated credentialing status with medical and dental payers
- Work with Patient Accounts and Billing to rectify any denied claims due to credentialing issues. Verify accuracy and communicate insurance information to other HealthPoint departments.
- Create, distribute, and maintain detailed reports for internal use by staff and for alignment with external payer partners
Must have’s you’ll need to be successful:
- Associates (AA) degree in healthcare or business field or equivalent from two-year college or technical school, or more; or at least two (2) related experience; or equivalent combination of education and experience.
- Demonstrated ability to be self-starter, motivated, independent worker with high attention to detail and ability to follow through.
- Position requires high level of prioritization and organization skills as well as strong ability to track processes and follow up on outliers.
Proof of immunity to varicella, measles, mumps and rubella is a condition of employment. Prospective employees must provide proof at time of offer.
If you know about the following it’s a plus:
- Three (3) years of experience in health care industry and credentialing strongly preferred.
- Experience with MD-Staff a plus.
- Experience with some type of credentialing software preferred.
HealthPoint is committed to offering all employees a competitive compensation, benefits and several other perks.
- Medical, Dental, Vision, Disability Coverage
- Employee Assistance Program
- Generous PTO Plan
- Paid Holidays
- Opportunity Time Off (extended time off for staff to invest in themselves)
- Retirement Plan with Employer Match
- Voluntary plans at a discount, such as life insurance and identity theft insurance
- Third Party Perks Discounted Movie Tickets, Travel, Hotels, and more
- Growth Opportunities
To learn more about HealthPoint, go to www.healthpointchc.org! #practiceyourpassion
It is the policy of HealthPoint to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex (including pregnancy), age, national origin, marital status, military status, sexual orientation, because of sensory, physical, or mental disability, genetic information, gender identity or any other factor protected by local, state or federal law, and to prohibit harassment or retaliation based on any of these factors.