Job Description

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

JOB SUMMARY:

The Provider Enrollment Credentialing Specialist position oversees and responds to group, location and provider enrollment with health plans, including Medicare, Medicaid and other governmental entities. The position will also be responsible for the day-to-day needs of provider enrollment for group, location and individual providers.  This position is responsible for supporting the mission, vision and values of Upstream Rehabilitation.

JOB RESPONSIBILITIES:

• 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.

JOB QUALIFICATIONS:

• High school diploma or equivalent experience.
• Prior experience in Medical Credentialing Process and Revenue cycle.
• 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.

CLICK HERE TO LEARN EVEN MORE ABOUT UPSTREAM