Credentialing Specialist – Provider Enrollment

IntelliCVO is a Wholly owned subsidiary of IntelliSoft Group, and is certified by the National Committee of Quality Assurance (NCQA). IntelliCVO is positioned for both organic and inorganic growth along with the growth that will come with the effective launch of the IntelliSolution product line that was introduced in the 4th quarter of 2016.


Position Summary

Responsible for all activities associated with researching, pre-populating and tracking the correct payer enrollment solution to facilitate a successful enrollment process for our clients with various health plans including but not limited to Medicare and/or Medicaid plans. Accurately maintain detailed records regarding the entire enrollment process within Intellisoft Database. Interacting frequently and effectively with the health plans, clients and staff.

Ideal Candidate Qualifications

  • Knowledge of CAQH and CMS standards preferred.
  • Ability to work independently and as a member of a team.
  • Proficient with general computer software (Word, Excel, Outlook required).
  • Self-motivated with an attention to detail.
  • Ability to organize, plan and prioritize daily work schedule.
  • Ability to maintain confidentiality.
  • Excellent customer service skills.
  • Excellent verbal and written communication skills.
  • Ability to maintain a professional manner even under stressful situations.
  • Previous credentialing and/or enrollment experience preferred.
  • Associates level or above desired, in lieu of degree, will consider individual with directly related experience in provider enrollment and/or credentialing in health care setting

Key Responsibilities

  • Maintain provider applications records and demographic information in our credentialing database.
  • Perform ongoing research to stay informed of changes effecting payor requirements.
  • Continued following up on missing information and/or status of enrollment request.
  • Meet required turnaround times and accuracy rates.
  • Analyze and evaluate data and other provider related problems to develop alternative solutions for a positive outcome.
  • Report generation based on client needs.
  • Stay informed of changes effecting payer requirements for provider enrollment.
  • Assist with other duties as assigned.

Education

High School Diploma or GED required

College courses and or college degree preferred

 

Please send your resume to Jennifer Cloud at jcloud@intellisoftgroup.com