What are the responsibilities and job description for the Credentialing & Payor Enrollment Representative 24-00827 position at Alura Workforce Solutions?
Position
Credentialing & Payor Enrollment Representative
(MD's, DO's, and PA's)
Position Summary
Join our client's dynamic team, where you will play a vital role in ensuring that our MDs, DOs, PAs, and other healthcare providers meet all necessary standards and qualifications. You will be responsible for managing the entire credentialing process, from collecting and verifying provider credentials to payor enrollment, maintaining accurate records and coordinating with various internal and external entities. Your work will directly impact the quality of care we provide by ensuring that only the most qualified providers are part of our network.
Our client provides a great culture, supportive team, and excellent working environment, which includes two remote workdays each month, employee incentives, awards, outings, and recognition for special achievements.
Description
Credentialing & Payor Enrollment Representative
(MD's, DO's, and PA's)
Position Summary
Join our client's dynamic team, where you will play a vital role in ensuring that our MDs, DOs, PAs, and other healthcare providers meet all necessary standards and qualifications. You will be responsible for managing the entire credentialing process, from collecting and verifying provider credentials to payor enrollment, maintaining accurate records and coordinating with various internal and external entities. Your work will directly impact the quality of care we provide by ensuring that only the most qualified providers are part of our network.
Our client provides a great culture, supportive team, and excellent working environment, which includes two remote workdays each month, employee incentives, awards, outings, and recognition for special achievements.
Description
- Process and manage all aspects of credentialing for healthcare providers within a managed care organization.
- Collect, review, and verify provider credentials, including licenses, certifications, education, and work history.
- Conduct primary source verification of credentials through various databases and organizations.
- Maintain accurate and up-to-date provider files and credentials providers with insurance payors including, HMO, MSO, IPA's, Medical Groups, Medicare and Medi-Cal, using CAQH, PECOS and PAVE
- Coordinate with internal departments and external entities to obtain necessary documentation and information.
- Assist in the development and implementation of credentialing policies and procedures.
- Respond to inquiries from providers regarding their credentialing status.
- 2 years of full-cycle credentialing experience in credentialing standards, regulations, and best practices required.
- Experiene credentialing providers with insurance payors such as, HMO, MSO, IPA's, Medical Groups, Medicare and Medi-Cal, using CAQH, PECOS and PAVE required
- Strong attention to detail and excellent organizational skills
- Experience in provider enrollment follow-ups.
- Excellent written and verbal communication skills.
- Proficient in Microsoft Office Suite.
- Full-Time, Onsite, Direct Placement, Benefited
- Compensation commensurate with experience.
Salary : $26 - $30
