What are the responsibilities and job description for the Insurance Payor Credentialing Enrollment Spec position at CAMcare Health Corporatio?
Who we are : CAMcare Health is made of a diverse and innovative team motivated to provide the best possible healthcare to communities in Camden and the surrounding communities. We live our values by providing primary health care to everyone regardless of their ability to pay at seven sites throughout Camden and Gloucester counties. Focused on leveling up patient care, incorporating technology, creative problem solving, and innovating healthcare every day.
How you can make an impact : The Insurance Payor Credentialing Enrollment Specialist will be responsible for managing the provider credentialing and enrollment processes across various payor sources, including CAQH , PECOS , NJ Medicaid , and Managed Care Organizations (MCOs) . This position requires a thorough understanding of healthcare provider enrollment procedures and the ability to meet key performance indicators (KPIs) related to credentialing and enrollment timelines, accuracy, and compliance. The Insurance Payor Credentialing Enrollment Specialist will report to the HR Director and work closely with the Billing Department.
What will You Do :
- Credentialing and Enrollment Management :
Oversee the credentialing and enrollment process for CAMcare Health Corporation’s providers in a timely, accurate, and efficient manner.
Ensure the maintenance and timely submission of provider profiles to the Council for Affordable Quality Healthcare (CAQH) database for payer credentialing purposes.
Handle the Medicare enrollment process via PECOS (Provider Enrollment, Chain, and Ownership System) , ensuring proper and timely submission of provider documentation for Medicare programs.
Manage the enrollment and revalidation of providers in NJ Medicaid , ensuring compliance with all state-specific requirements and timely submission of documents.
Coordinate and manage the enrollment of CAMcare Health Corporation providers with various Managed Care Organizations (MCOs) .
Keep up-to-date on all relevant federal, state, and payor-specific credentialing and enrollment policies, including those of CMS, NJ Medicaid, and MCOs.
Serve as the main point of contact for providers and insurance payors regarding credentialing and enrollment issues.
Maintain organized records of all credentialing and enrollment activities, including documentation of provider contracts, enrollment forms, and communication with insurance payors.
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