Payor Enrollment Specialist (SC Remote)

Position Summary: Processes credentialing and re-credentialing applications and Credentialing Vendor requests for OBHG health care providers.

Payor Enrollment Specialist Responsibilities:  Essential 

• Maintain credentialing information by reviewing, entering and following up on missing
• Establish and maintain professional relationship with providers, insurance providers, client contacts and account service/credential
• Submit and follow up on request for signatures in a timely
• Respond to credentialing
• Contact and respond to request to/from hospitals and health payers for verification of provider's credentials, ensuring credentialing and licensing processes are completed
• Responsible for the processing and preparation of the applications for insurance payer participation with the ability to manage multiple facilities'/payers' enrollment requirements, which includes non-application requests that are indicated by OBHG staff and/or facility/payer.
• Track credentialing application
• Maintains providers/practitioner files including maintenance of the OBHG provider database, individual CAQH profiles and providers rosters by identifying who may need updating or re­ credentialing and process
• Maintains and updates CRM, Mail and Utility Logs for provider's licensure, board certifications and certificate of
• Escalate non-responsiveness of MD to Supervisor with documentation of
• Meet required turnaround times and accuracy
• Ensure all Protected Health Information is kept in a secure location at all times and maintain Compliance by communicating credentialing request, status and issues to the Corporate Compliance
• Participate in the credentialing committee as
• Perform other duties as assigned by Payer Enrollment Manager and/or Management

Payor Enrollment Specialist Essential Skills/Credentials/Experience/Education

• Five years’ experience in payor enrollment for Medicaid and Managed Care payors.
• Strong organizational skills and attention to
• A minimum of a High School Diploma or equivalent is required; some college or equivalent experience is preferred.

Preferred Skills/Credentials/Experience/Education

• Strong telephone
• Strong computer skills, proficient in Word, Excel &
• Preferred understanding of medical
• CPCS credentialing

Mental and Physical Demands (per ADA guidelines)

•  Physical Demands: Sitting for long periods of Occupation requires this activity more than 66% of the time (2.6 hrs/day)
• Travel Demands: May require occasional travel to corporate headquarters in Greenville, SC

Hourly Compensation: $21.00 - $24.00 (based on experience)

What We Offer - The Good Stuff:

• A mission based company with an amazing company culture.
• Paid time off & holidays so you can spend time with the people you love.
• Medical, dental, and vision insurance for you and your loved ones.
• Health Savings Account (with employer contribution) or Flexible Spending Account options.
• Paid Parental Leave
• Employer Paid Basic Life and AD&D Insurance.
• Employer Paid Short- and Long-Term Disability.
• Optional Short Term Disability Buy-up plan.
• 401(k) Savings Plan, with ROTH option.
• Legal Plan.
• Identity Theft Services.
• Mental health support and resources.
• Employee Referral program – join our team, bring your friends, and get paid.

Salary : $21 - $24