Enrollment & Credentialing Specialist chez HealthSource of Ohio

Job Summary:

Responsible for all aspects of payer credentialing, re-credentialing, and provider enrollment processes for the providers of HealthSource and Centerprise’ s clients. Responsible for ensuring providers are credentialed and enrolled with the various

Medical, Dental, Vision and Behavioral Health plans. Maintain up to date data for each provider in credentialing database and online systems. Communicate with HealthSource and Centerprise clients regarding credentialing and re-credentialing terms and changes.

Job Duties and Reponsibilities:

1. Delivers the HSO brand promise of putting the patient/customer at the center of all we do.

2. Facilitate provider credentialing and re-credentialing, obtaining required information as needed.

3. Maintains current copies of state licenses, DEA Certificate, Malpractice, Board Certifications etc.

4. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed. Ensures timely processing of all credentialing requests.

5. Maintains knowledge of current health plan and agency requirements for credentialing and enrolling providers.

6. Sets up and maintains provider information in online credentialing databases and systems, including CAQH to assure all credentialing information is accurate and up to date.

7. Maintain up to date credentialing database (CMD).

8. Maintain and update credentialing reports. Keeps an updated log of all pending and completed work in database (CMD).

9. Ensures provider and facility locations are current with health plans, agencies and other entities.

10. Audits health plan directories for current and accurate provider information.

11. Communicates health plan coverage changes, additions, deletions across HealthSource and Centerprise clients.

12. Assists billing staff on issues pertaining to Credentialing.

13. Exhibits brand characteristics of Friendly, Accessible, and Credible

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty completely. The requirements listed below are representative of the knowledge skill and/or ability required.

Minimum Qualifications:

• To be eligible for remote portion, must have reliable Internet connection with a minimum download speed of at least 5Mbps, and upload speed at least 1 Mbps. Must have a dedicated work area with a door.
• High School Diploma or Equivalent (GED), Associate Degree preferred. 
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Knowledge and understanding of the credentialing process. 2+ years of enrollment and credentialing experience required. FQHC experience is a plus.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent attention to detail.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets.
• Familiarity and experience with CAQH and NCQA
• Excellent written and oral communication skills

Pay: $24-$27/hour based on experience

Benefits: 

• Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts
• 401 (k) Program with competitive company match
• Courtesy Plan, full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio office up to $500.00 per family
• PTO and Long-Term Sick Bank, full time employees earn up to 25 days per year in first calendar year: 15 days of Paid Time Off (PTO), and 10 days of Long-Term Sick Bank (LTSB)
• Credit Union Privileges, Sharefax Credit Union
• Quarterly Bonus Incentive Program

Schedule: 

• Monday to Friday; no evenings, or weekends
• 30-days in office training required. After 30 days, eligible to work a hybrid-remote schedule which will include 2-3 in office days per week.

Work Location: Hybrid remote in Loveland, OH 45140. Must be able to commute or planning to relocate before starting work.