Credentialing & Provider Enrollment Specialist

Washington, DC, United States

Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services. Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services. We are recruiting for the following position:

Sea Mar is a mandatory COVID-19 and flu vaccine organization

Credentialing & Provider Enrollment Specialist - Posting #26191

Hourly Rate: $25.00 - $29.00

Annual Salary: $52,000 - $60,000

This is an on-site office position, not remote.

Position Summary:

Sea Mar Community Health Centersseeksan experienced Credentialing & Provider Enrollment Specialist.This is a Full-time position(Monday-Friday) 8:00 am to 5:00 pm. The Credentialing Specialistbe responsible for coordinating all aspects of the privileging and credentialing process for the licensed independent practitioners (LIPs) in accordance with the Policies & Procedures, national standards and regulatory requirements.

Duties and Responsibilities:

Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.

Create and carry out various credentialing processes in relation to licensed providers in medical, dental and behavioral health departments.

Ensure that all credentialed providers adhere to facility and staff policies, department guidelines, regulations, and government laws.

Process applications and reappointment paperwork, checking for full completeness and accuracy.

Perform provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to Board of Directors.

Ensure that all credentialfiles are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per HPP and/or client facility policy and procedures.

Coordinate credentialing process by entering/logging/scanning information into MD Staff credentialing software for initial, updating, and add on applications and maintenance processes.

Collect and verify sensitive provider data through confidential sources.

Maintain timely updates to information systems and regular reports used to monitor completion of initial and reappointment credentialing applications.

Audit files based on internal standards and regulatory requirements.

Monitor and report application status and provide appropriate correspondence (form letters) to providers and department heads when necessary.

Provide complete and accurate credentialing files to Administration for inclusion in Board of Directors’ materials.

Qualifications :

Working knowledge of Joint Commission, NCQA and CMS credentialing and privileging standards and experience with provider and health plan credentialing.

Intermediate computer skills including Microsoft products and web based queries.

Demonstrated ability to manage and meet multiple priorities and competing deadlines, problem solving and organization skills with attention to details. Experience with credentialing software is desirable, MD Staff preferred.

Education and/or Training :

Current NAMSS Certified Provider Credentialing Specialist (CPCS) or willing to begin actively pursuing certification upon hire.

Previous work experience in managed care, hospital or medical office environment required.

Experience with delegated health plan credentialing agreements preferred.

The successful candidate will have the following qualifications:

Excellent verbal and written communication skills, including ability to compile, interpret, and utilize information; and to communicate effectively with people of all backgrounds and educational levels.

Ability to work with minimal supervision, use good judgment, meet deadlines, and prioritize workloads.

Ability to maintain confidentiality.

Well organized and have good attention to detail.

Computer literate and have good mathematical skills. Experience in Windows Office programs and data entry preferred.

Ability to solve problems and reason deductively.

College degree preferred, high school diploma acceptable if previous work experience in managed care, hospital or medical office environment.

Ability to fluently speak and read English required; bilingual English/Spanish preferred.

Highly desirable skills and experience:

Healthcare billing experience

Payer relations, enrollment, and reimbursement

Knowledge of medical terminology

Insurance verification

Health plan contracts

Exposure to Medicaid and Medicare plans and programs

Understanding of healthcare compliance

Medical Staff Services experience

Hospital privileging

One Health Port (OHP) and Provider One.

What We Offer:

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. Working at Sea Mar Community Health Centers is more than just a job, it’s a fulfilling career with opportunity for advancement. The fringe benefits surpass most companies. For example, employees Full-time employees working 30 hours or more, receive an excellent benefit package of Medical, Dental, Vision, Life Insurance, Prescription coverage, Long Term Disability, EAP (Employee Assistance Program), paid-time-off starting at 24days per year + 10 paid Holidays. We offer 401(k)/Retirement options and an exciting opportunity to work in a culturally diverse environment.

How to Apply:

To apply for this position, complete the online application and click SUBMIT or APPLY NOW. If you have any questions regarding the position, email Stephanie Fox, Credentialing & Provider Enrollment Supervisor at [email protected] .

Sea Mar is an Equal Opportunity Employer

Posted on 3/5/2024

Please visit our website to learn more about Sea Marat www.seamar.org. Follow us onFacebook,Twitter, andInstagram

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