Provider Enrollment and Credentialing Specialist

Job Description

REQUIREMENTS

• Strong understanding of managed care systems and provider enrollment procedures.
• 2-3 years or previous credentialing experience.
• Proficiency in medical terminology to accurately interpret provider credentials and documentation.
• Excellent organizational skills with the ability to manage multiple applications simultaneously under tight deadlines.
• Effective communication skills for liaising with providers, insurance companies, and internal teams.
• Attention to detail to ensure accuracy in all aspects of credentialing and enrollment activities. 

RESPONSIBILITIES

• Coordinate and complete provider enrollment applications with managed care Medicaid, MCOs and Commercial Carriers. Preference given to Washington State residents.
• Register licensed provider with WA Medicaid and complete provider interest forms for commercial carrier. Register certified providers with WA Medicaid and roster with Medicaid MCOs.
• Maintain up-to-date provider records in compliance with regulatory requirements and organizational policies.
• Collaborate with medical offices to gather necessary documentation and resolve enrollment issues promptly.
• Track application statuses, follow up on pending submissions, and ensure timely credentialing processes.
• Review and interpret medical terminology related to provider credentials and enrollment documentation for accuracy.

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