Nomi Health is hiring a
Healthcare Credentialing and Enrollment Specialist

Summary

We are seeking an experienced Healthcare Credentialing and Enrollment Specialist to manage the credentialing process for healthcare providers, initiate enrollments with various insurance plans, verify provider credentials, maintain accurate databases, and ensure compliance with regulations. The ideal candidate should have a Bachelor's degree in Healthcare Administration or related field, 3 years of experience in healthcare credentialing and enrollment, strong organizational skills, excellent communication skills, and proficiency in using credentialing software.

Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field (or equivalent work experience)
• Minimum of 3 years of experience in healthcare credentialing and enrollment
• Strong knowledge with credentialing standards, regulations, and procedures
• Proficiency in using credentialing software and databases
• Excellent communication and interpersonal skills

Responsibilities

• Manage the credentialing process for healthcare providers
• Initiate and complete enrollment applications with various insurance plans and networks
• Verify provider credentials, licenses, certifications, and relevant documentation required for credentialing and enrollment
• Manage multiple deadlines effectively to ensure timely provider participation in insurance networks
• Foster positive relationships and engage with healthcare providers
• Maintain and update provider profiles and rosters with accurate information
• Ensure compliance with all regulatory requirements and standards related to credentialing and enrollment
• Maintain accurate and updated provider information in credentialing and enrollment databases
• Address and resolve issues related to credentialing and enrollment
• Lead a team of credentialing specialists, train administrative assistants, and develop efficient workflows

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
• Experience working in a healthcare setting, such as a hospital, clinic, or healthcare management organization
• Familiarity with Medicare, Medicaid, and commercial insurance plans
• Expert knowledge navigating Medicaid state websites, provider enrollments and ID updates, and group enrollments

Benefits

Health insurance