Credentialing specialist Jobs in Norwalk ca
Last updated: 7 hours ago
Credentialing & Enrollmt Assoc
Stamford HealthStamford, CT, United States- Promoted
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FastenalStamford, CT, United States Show moreLast updated: 30+ days ago
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Interview HuntersStamford, Connecticut, US- Promoted
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Centurion Group LLCStamford, CT, United States- Promoted
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Math Specialist
OutlierStamford, CT, United States Show moreLast updated: 30+ days ago
- Promoted
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Field Operations Specialist
GunnerStamford, CT, United States- Promoted
- Promoted
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Programmatic Specialist
Mars United CommerceStamford, Connecticut, USCredentialing & Enrollmt Assoc
Stamford HealthStamford, CT, United States30+ days ago
Job type
- Full-time
Job descriptionAssemble, organize and present factual provider information derived from a variety of original and secondary sources. Accurately complete the enrollment / reenrollment processes as outlined by each payor for all appropriate healthcare providers to ensure timely and continued provider network participation. Process appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and maintains appropriate documentation. Maintain detailed provider credential and enrollment files in appropriate format, paper and / or electronic including electronically received documents and scanning of hardcopy documents. Maintain provider NPI information via the NPI Registry website. Maintain thorough documentation of each stage of the enrollment / reenrollment process. Provide for timely and thorough follow up of pending applications. Accurately update and maintain all internal systems and resources with appropriate provider and network participation information. Maintain required confidentiality concerning privileged information within the department. Develop and maintain good working relationships with the organizations providers and support staff to obtain necessary and timely information to facilitate the provider enrollment / reenrollment process. Develop and maintain relationships with Payor Representatives in order to facilitate the provider enrollment / reenrollment processes. Respond to and resolve problems with provider numbers and / or participation status as it relates to denial of services or reimbursement by working closely with all levels of administrative and clinical personnel and payor representatives. Responsible for educating providers, administrators and support staff regarding the enrollment / reenrollment processes and how it relates to the provider's ability to provide care to network members in order to increases reimbursement and reduce patient dissatisfaction. Supports the Manager in the development of departmental policies, workflows, processes, and systems. Performs other related duties as assigned or requested in order to maintain a high level of service. Completes required continuous training and education, including department specific requirements. Demonstrates professional work behavior Service Standards and Code of Conduct. Complies with departmental organizational policies and procedures and adheres to external agency requirements. Efficiently manages assigned projects from beginning to conclusion. High school required. College coursework preferred. Three or more years’ experience working in physician credentialing and / or enrollment preferred. Working knowledge of credentialing, provider enrollment processes, requirements and terminology for commercial insurance companies and government sponsored plans . Medicare and Medicaid as well as relevant terminology a plus. Familiarity with group and provider credentialing documents, . licensure, medical school and training documentation, board certifications, etc. Strong organizational, analytical and problem solving skills. Ability to work independently while contributing to a team environment; ability to make sound and timely decisions. Effective interpersonal skills with the ability to interact with all levels of management, staff and providers. Demonstrated ability to effectively communicate both in writing and verbally; excellent presentation skills. Demonstrated computer skills; proficient with MS Windows applications including but not limited to Word, Excel and Outlook. Demonstrated ability to conduct Internet based research to identify credentialing and enrollment specific guidelines and instructions. Experience working with credentialing software a plus.
Stamford Health is a well-established, award-winning Healthcare System with multiple locations in CT.
As a new Certified Great Place to Work organization, Stamford Health understands what it takes to attract talent in order to improve our workforce and support our mission, to that end we offer :
- Competitive salary
- Sign on bonuses for designated positions
- Comprehensive, low-cost health insurance plans available day one
- Wellness programs
- Paid Time Off accruals
- Tax deferred annuity and (403b) pension plan
- Tuition reimbursement
- Free on-site parking and train station shuttle
- Childcare partnership with Children’s Learning Center
The Credentialing and Enrollment Associate performs administrative and technical dutiesrequiring accuracy and attention to detail involved in the enrollment and re-enrollment of Stamford Health Medical Group and its healthcare providers with all third party and government payors with whom there are contracts or agreements for the reimbursement of services. This position has continuous contact with internal and external customers including physicians and other healthcare providers, administrators, support staff and payor representatives. Additionally, this position is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered.