Credentialing & Enrollment Specialist

2+ years experience in managed care credentialing, billing and/or Medical Staff service setting
Knowledge of FL payers required
Demonstrated skills in problem solving and analysis and resolution
Advanced Microsoft Excel skills required
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations

Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing
Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
Works with both internal and external stakeholders to resolve complex provider enrollment issues, including resolving claim denials related to provider enrollment
Supports special projects requiring knowledge of delegated and non-delegated health plan requirements
Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications
Maintains confidentiality of provider information
Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
Coordinate and prepare reports
Record and track credentialing statistics
Other duties as assigned.