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Credentialing Specialist

Company: Elevate ENT Partners
Location: Miami
Posted on: May 16, 2022

Job Description:

Elevate ENT Partners is a leading practice management support organization that caters to the needs of ear, nose, and throat (ENT) practices nationwide. Our mission is to elevate private practices by providing scalable administrative support that removes barriers to quality care and enables ENT practitioners to achieve more while securing their future. We envision the next generation of ENT care in which we help preserve private practices by enabling their independence and empowering their success. At Elevate ENT Partners, we are committed to delivering high quality patient care and the highest level of employee satisfaction. We are always seeking to attract and retain the industry's best talent-people who are passionate about what they do and want to make a positive impact in the dynamic field of healthcare. Are you one of them?

Large group physician practice has full-time opening for a Credentialing Specialist. Credentialing Specialist will be responsible for managing all aspects of credentialing and privileging processes for Physicians and Ancillary providers.
Job FunctionsUnderstands and completes all roles in the Credentialing Department related to provider management:Onboarding

  • Working with providers and offices to obtain complete records from new providers
  • Verifying data and interpreting results
  • Data entry and file setup
  • Timely processing and presentation for approvalEnrollment
    • Completing third party applications for payers, facilities, malpractice insurance, etc.
    • Working effectively and professionally with providers and contacts to follow the process through approvalMaintenance
      • Keeping providers records up to date and current with internal standards
      • Responding to payer and facility requests for re-processing applications on schedule
      • Running reports on all credentials/expirables such as licenses, DEA's, CPR certificates, etc. and maintaining current copies
      • Reporting continue education credits to CE Broker
      • Educating providers and offices on processes and assisting in issue resolution
      • Intake and appropriate processing of requests from all external and internal parties
      • Responding and assisting in the resolution of billing and claims issues
      • Making sure external sources are updated regularly such as CAQH, NPI, etc.Establishes and maintains a strong working relationship with company staff, providers, third-party payers, and all other entities.Participates in delegated credentialing activities as may differ from the above tasksSupports the Credentialing Department with special projects as neededOther duties as assigned by Manager
        Abilities Required
        • Minimum 3 years' experience in the credentialing field
        • CPCS (Certified Provider Credentialing Specialist) preferred
        • Proficient with Microsoft Applications (Word, Excel, Outlook) and Windows
        • Strong data entry skills
        • Professional written and spoken communication skills
        • Working knowledge of Credential My Doc Software (will be taught)
        • High level of attention to detail
        • Ability to handle multiple documents pertaining to several providers at once
        • Applying complex, detailed guidelines in the preparation and review of all applications to ensure compliance with CMS, state regulations, NCQA and internal procedures and protocols
        • Excellent time management skills to handle multiple tasks simultaneously
        • Demonstrated ability to work independently and prioritize work
        • Team orientation & flexibility in accepting change
          AAP/EEO Statement In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Elevate ENT will be based on qualifications and job related abilities. Elevate ENT does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, ancestry, sexual orientation, marital status, gender identity or any other characteristic protected by law. Elevate ENT will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in undue hardship.

Keywords: Elevate ENT Partners, Miami , Credentialing Specialist, Other , Miami, Florida

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