Credentialing Specialist (Provider Enrollment)

Avoca - Dublin, OH

Full-time - Entry Level

Remote - Dublin, OH

Professional, Scientific, and Technical Services

About the position

The Credentialing Specialist (Provider Enrollment) is responsible for coordinating the credentialing and re-credentialing processes for Advocate clients. This role ensures the accuracy and completeness of all documentation in compliance with state and federal requirements. The position offers flexibility with options for remote or hybrid work from the Dublin, OH office.

Responsibilities

• Facilitates initial appointment, re-appointment, and tracking of expired documents.
• Reviews provider credentialing applications for completeness, accuracy, and compliance with current credentialing guidelines, NCQA, state, and federal requirements.
• Performs primary source verification of all applicant licensure, education and training, relevant employment history, and affiliations.
• Assesses risk exposure during and at the time of recredentialing.
• Maintains the accuracy and integrity of the credentialing database system and related applications.
• Works with payors to ensure proper enrollment for billing and payment receipt.
• Performs other related duties as assigned.

Requirements

• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite and proprietary database applications.
• Ability to use independent judgment and manage confidential information.
• Ability to multi-task, manage priorities, and meet critical deadlines.
• Ability to work independently in a fast-paced environment.
• High level of awareness of pertinent details and excellent organizational skills.
• High school diploma or equivalent required; college degree preferred.
• One to two years credentialing and provider experience preferred; at least one year of medical billing experience preferred.

Nice-to-haves

• College degree preferred.
• Experience in medical billing.

Benefits

• 401(k) matching
• AD&D insurance
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• HSA Wellness Program with $600 employer contribution
• Annual biometric screenings
• Employee appreciation days
• Company swag on day one
• PTO and sick time
• Ten paid holidays including the day after Thanksgiving and Christmas Eve
• Referral bonuses
• Potential for hybrid work schedule
• Parental leave
• Employer-paid short/long-term disability and Life/AD&D
• Employee of the Month bonuses