Credentialing Enrollment Specialist

• This position follows a standard schedule of Monday through Friday, from 8:00 AM to 4:30 PM, with the potential for overtime hours during our busy season (June - November primarily) based on workload demands and operational needs. No holidays

• Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

• Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).

• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

ersees the internal processes and procedures as well as Governmental, and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning, development, and organization.

• Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.

• Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.

• Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.

• Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.

• Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.

• Conducts practice site visits for practices within MGD. Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.

• Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation.

• Provides Team member support to the CPN Credentialing and Quality Review Committee.

• High school diploma or GED

• Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is .

• Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone

• Experience in typing, word processing, and business correspondence

• Bachelor's degree

• Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.

• Perform most duties under normal office conditions which may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles 20-50 pounds.

• Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone or other employees.

• Must use frequent and variable body movements during filing and maintaining records.

• Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies.

• Require occasional travel to other corporate offices.

• Intact sense of sight and hearing required.

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.