Chaparral Medical Group Inc · 1 month ago
Provider Enrollment Specialist
Pomona
Full-time
Onsite
Mid Level
$24/hr - $34/hr
3+ years expChaparral Medical Group is a leading primary and multi-specialty care provider in California’s Inland Empire, which recently partnered with Akido Labs to enhance healthcare delivery. The Provider Enrollment Specialist will be responsible for ensuring that providers are credentialed and enrolled efficiently, thus facilitating uninterrupted patient care.
Health CareMedicalPersonal Health
Responsibilities
Filling out provider enrollment applications with health plans, Medicare, Medicaid and hospitals
Following up with health plans and hospitals on submitted applications
Solve complicated credentialing-related issues directly with IPAs and health plans
Maintaining a clean database of provider data and enrollment-related activities in MD Staff
Applying for license renewals
Communicating with providers on credentialing-related updates
Work amongst a team of credentialing/enrollment specialists to deliver accurate, timely, and compliant work - including completing credentialing/enrollment tasks
Process credentialing, re-credentialing, and privileging applications to keep providers active and patient care uninterrupted
Solve enrollment-related issues as they arise, working directly with health plans to get them resolved
Monitor application timelines to prevent delays and resolve escalated issues from staff, clinics, and providers
Maintain high data quality, including both provider data as well as credentialing data, like expiration dates, contact information, etc
Follow SOPs and policies that are designed to streamline workflows and strengthen compliance
Maintain compliance with the state, federal, and payer-specific credentialing requirements
Act as a liaison for external partners, including payers, hospitals, and credentialing verification organizations
Qualification
Required
3+ years of experience in provider credentialing/enrollment
Strong knowledge of NCQA standards, payer requirements, and credentialing best practices
Excellent problem-solving and critical thinking skills, with the ability to resolve escalated issues
Exceptional organization skills, with sharp attention to detail and ability to manage multiple priorities
Strong written and verbal communication and interpersonal skills to collaborate cross-functionally and with external stakeholders
Preferred
Bachelor's degree in healthcare administration, business, or related field
Experience with credentialing/enrollment software and databases
Benefits
Health benefits include medical, dental and vision
401K
Life insurance
Wellness benefit
Company
Chaparral Medical Group Inc
Over the past 40 years, Chaparral Medical Group (CMG) has established itself as a leading primary and multi-specialty care provider for California’s Inland Empire.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase