Credentialing & Enrollment Specialist II
Tasks
- Collect and follow up on missing provider documentation
- Coordinate provider billing activation
- Correct roster discrepancies
- Execute provider onboarding readiness tasks
- Execute roster additions updates and terminations
- Follow up on payer enrollment applications through completion
- Follow up on payer issue tickets and cases
- Follow up with providers on missing items
- Gather audit evidence
- Handle provider onboarding communications and documentation guidance
- Maintain CAQH and PECOS profiles
- Maintain credentialing platform records and internal trackers
- Maintain payer contact lists and portal access
- Maintain payer portal accounts
- Maintain provider demographic data across systems
- Manage provider issue intake and routing
- Monitor primary source verifications
- Perform PSV according to NCQA standards
- Perform credentialing file QA
- Prepare delegated credentialing files
- Process provider status changes terminations and reactivations
- Resolve roster related billing issues
- Review CVO processed files for completeness and accuracy
- Submit and complete group and individual payer enrollment applications
- Support claim denial triage for enrollment related issues
- Track enrollment statuses and update Salesforce
- Track insurance expiration dates and follow up on renewals
- Track provider expirables and renewal timelines
- Verify initial credentialing and recredentialing applications
- Verify provider malpractice policies and insurance documents
Perks/Benefits
- 401k
- Fully-paid health care
- Life insurance
- Long-term disability
- Parental leave
- Pet insurance
- Remote work
- Short-term disability
- Sick leave
- Unlimited PTO
Skills/Tech-stack
Availity | CAQH | Credentialing | Enrollment | NCQA | PECOS | Payer Portals | Payer enrollment | Primary Source Verification | Salesforce | Source verification
Education
N/A
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