Credentialing & Enrollment Specialist

Summary

The job is for a Credentialing Specialist at Imagine Pediatrics, a pediatrician-led medical group that provides virtual-first care services. The role involves reviewing and screening credentialing applications, managing the end-to-end process of acquiring new licenses for behavioral health staff, and maintaining data from provider applications into credentialing databases.

Requirements

• 3-5+ years of experience handling payer credentialing
• Extensive experience credentialing and enrolling behavioral health professionals (LCSW, LMFT, LPC, etc.)
• Extensive experience with Medicaid in a multi-state organization. Telehealth experience strongly preferred

Responsibilities

• Reviews and screens initial and re-enrollment credentialing applications for completeness, accuracy, and compliance with federal and state regulations
• Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements
• Manages the end-to-end process of acquiring new licenses for behavioral health staff
• Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies
• Enters, updates, and maintains data from provider applications into credentialing database (Medallion), focusing on accuracy
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications
• Participates in the development and implementation of process improvements for the system-wide credentialing process
• Communicates clearly with providers, their liaisons, medical leadership and administration, as needed to provide timely responses upon request on day-to-day credentialing issues as they arise
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry

Benefits

• Full medical, dental, and vision insurance
• Healthcare and Dependent Care FSA
• 401(k) with 4% match, vested 100% from day one
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid parental leave