OCHIN describes itself as a nonprofit leader in equitable healthcare innovation. As an employer, the organization strives to build a challenging yet rewarding w
Enrollment Specialist
Location
United States
Posted
19 hours ago
Salary
$23 - $47 / hour
Seniority
Senior
Job Description
Enrollment Specialist
OCHIN
• Perform all aspects of the payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties • Manage credentialing applications, verify credentials, and maintain provider files internally and externally with payor plans • Timely processing of initial credentialing and recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards) • Review and analyze credentialing applications and supporting documents for accuracy and completeness • Validate and verify provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources • Identify discrepancies in information, conducting research and follow-up, and escalate unresolved issues • Complete payor provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system • Other duties as assigned
Job Requirements
- Minimum of three (3) years of progressive experience in Provider Enrollment, 5+ years preferred
- In-depth knowledge of Provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) preferred
- Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred (Must be NAMSS not AAPC)
- Proficiency in credentialing software and data management systems is preferred
- Experience with New York payers preferred
- Experience in MD-Staff preferred
- Advanced Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) preferred
- Working knowledge of Smartsheet including data structure, formula creation, basic workflows and automation preferred
- Proven experience in client-facing roles, with the ability to build strong relationships and communicate effectively with diverse stakeholders preferred
- Familiarity with Jira for issue tracking and task management preferred
Benefits
- Comprehensive range of benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible working arrangements
- Professional development opportunities
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