Medical Staff Credentialing Specialist
Atlanta, GA| Operations
The Provider Enrollment Specialist administers the physician and mid-level enrollment applications process for Medicare and Medicaid. The Provider Enrollment Specialist is responsible for preparing and submitting supporting documentation for the purpose of enrolling individual physicians, mid-levels and facilities with Medicare and Medicaid. This position is also responsible for follow up on the status of applications for physician, mid-levels, and facilities, and track the progress on all pending applications.
- High School Diploma or GED required
- Bachelor’s Degree preferred
- Minimum of 2 years’ experience in a larger or similar-sized company required.
- Knowledge of Medicare and Medicaid provider enrollment process.
Additional Knowledge, Skills and Abilities Required
- Proficiency in Microsoft Office, particularly Word and Excel.
- Professional written and verbal communication and interpersonal skills.
- Ability to participate and facilitate group meetings.
- Ability to effectively communicate with team members, supervisors, JV partners, and insurance contacts.
- Ability to maintain complete confidentiality in handling sensitive enrollment issues.
- Implements the physician enrollment process for physicians and mid-levels with Medicare and Medicaid.
- Maintain the timelines on enrollment schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
- Reviews new client packet information to determine any enrollment issues.
- Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance and state insurance form.
- Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment.
- Obtains required client signatures and follows up with the carriers on documentation submitted.
- Maintains provider information and demographics for all providers.
- Responds to internal and external inquiries on routine enrollment and contract matters.
- Monitors and advises clients on enrollment revalidations.
- Performs other related duties, which may be inclusive, but not listed in the job description
All other duties as assigned.
Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.
GoHealth Urgent Care invites military veterans to apply for our positions.
GoHealth provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, GoHealth complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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GoHealth Urgent Care has outstanding career opportunities in Connecticut, Missouri, New York City, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust them or burn them out, our team can balance and prioritize their professional and personal lives.
The lifestyle you can lead.
Atlanta is Georgia’s state capital and home to approximately half a million residents. Well known for its arts, theater, galleries and museums, cultural attractions, and institutions of higher education, Atlanta offers many things to do. Visit Georgia Aquarium, the largest public aquarium in the Western Hemisphere. Shop and enjoy great entertainment in Underground Atlanta. See wildlife shows at Zoo Atlanta. Catch a pro football, basketball or baseball game. Foodies will delight in local favorites, such as crab fritters, chicken biscuits, pulled pork sandwiches and salted caramel ice cream. Choose from many welcoming neighborhoods to live in, from downtown and midtown to Chastain Park, and from Buckhead to Cabbagetown, Kirkwood and Morningside. There’s also a good selection of public and private schools and nearby colleges and universities. Public transportation is excellent, and Atlanta is also served by Amtrak and Hartsfield-Jackson Atlanta International Airport.