Job Description

Upstream Rehabilitation, is looking for a Credentialing and Enrollment Specialist to join our team

Responsible for all aspects of the credentialing & re-credentialing all medical providers & groups who provide patient care to individual partner groups that fall under Benchmark Rehab Partners LLC. Ensure providers are credentialed, appointed, and privileged with contracted health plans. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. This position is responsible for supporting the mission, vision and values of Upstream Rehabilitation.

RESPONSABILITIES:

• Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database OneApp. 
• Maintain practitioner paper and electronic data files for practitioners 
• Use the CAQH system to submit practitioner data as required by some client health plans to credential individual practitioners. 
• Initial setup and/or maintenance of approved participating online payer systems.
• Completes provider credentialing and re-credentialing applications. 
• Monitors applications and follows-up as needed to ensure enrollment with contracted health plans. 
• Maintains copies of current state licenses and any other required credentialing documents for all assigned providers.
• Collaborate with HR to facilitate onboarding for all practitioners. 
• Communicate with field & therapist during the credentialing process and respond to field inquires in relation to credentialing request. 
• Communicate with payers for necessary updates and processes.
• Uphold Federal & State regulations in regards to credentialing & licensing of clinicians agencies
• This position may cross-train to perform tasks from other positions. 
• Other duties as assigned.

QUALIFICATIONS:

• High school diploma or equivalent experience
• Attention to detail, self-motivated and the ability to communicate effectively.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. 
• Proficient use of Microsoft Office applications (Word, Excel, Adobe) and internet resources. 
• Ability to organize and prioritize work and manage multiple priorities and deadlines

Fulltime positions include:

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match

Follow @Lifeatupstream on Instagram, and check out our LinkedIn company page to learn more about what it’s like to be part of the #upstreamfamily.

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