Vivo Infusion® · 2 days ago
Credentialing & Enrollment Specialist (CPCS or CPMSM), Full-Time- Remote
United States
Full-time
Remote
Entry, Mid Level
$26/hr - $32/hr
2+ years expVivo Infusion is seeking a detail-oriented Credentialing and Enrollment Specialist to join the growing Managed Care Team. In this role, you will be responsible for reviewing and authenticating credentials, qualifications, licenses, certifications, and other relevant documents for new and existing providers, ensuring compliance and smooth onboarding processes.
Health CareHospitalTherapeuticsWellness
Responsibilities
Reviewing and processing the onboarding and credentialing of MD’s, DO’s, NP’s and PA’s
Re-credentialing existing providers
Primary source verification of provider backgrounds by calling hospitals, licensing boards, medical schools, etc
Monitoring and reporting on the credentialing progress of each provider
Maintaining provider credentialing files and ensuring all licensing/certifications are up to date
Must have in-depth knowledge of managed care concepts, industry terms, contracting and provider enrollment life cycle
Experience enrolling MD's, DO's and APP's with commercial payers, Managed Medicare and Managed Medicaid plans
Working knowledge of CAQH profile management, attestation and PECOS
Ability to work independently and within a team to track, manage, escalate and resolve the entire provider enrollment process
Ability to use credentialing software and platforms to track pending applications
Maintain and build working knowledge of all payers, markets, contracted relationships, providers, provider types and necessary requirements to complete enrollment in a timely AND accurate fashion
Develop strong relationships with clinical staff, payers and operations
Confidence and experience handling escalation processes to achieve desired outcomes
Ability to think outside the box and solve complex issues as it relates to the provider enrollment process
In-depth knowledge of national and local payors and markets throughout the country that VIVO has a presence in
Ensure the appropriate processes are in place to monitor and maintain systematic and timely enrollment, contracting, and licensing efforts with various health plans and facilities throughout the United States
Scrutinizing provider applications and resumes for completion, consistency and accuracy. This includes quickly identifying any discrepancies, gaps of employment and other challenges that could negatively impact our ability to credential a provider
Running queries, reviewing NPDB reports, and conducting compliance and sanctions monitoring, as well as immediately notifying the recruiter and leaders of negative findings
Mailing, faxing and emailing to obtain verifications, references and other pertinent data from appropriate sources in a timely manner
Working closely with our physicians, client medical staff departments, and any third-party groups to follow up on outstanding items needed to complete files in a timely manner. This is to ensure that we meet applicable committee meeting dates and targeted start dates
Conducting physician peer references over the phone to verify each provider’s clinical competencies
Utilizing the CAQH database to enter and update physician data as needed for certain clients
Responding in a timely manner to all requests from finance, RCM, operations, physicians and or APP’s
Coordinate with HR and Clinic Managers during the provider hiring and onboarding process to ensure timely cred of providers
Working with our Clinical and Regulatory Services Department to ensure credentialing and accreditation standards are being met
Working with our Compliance Officer to complete regular credentialing audits
Creating and issuing Temporary and Full Privileges letters to the appropriate staff and supervisors
Qualification
Required
High School Diploma or equivalent
2 years of credentialing and enrollment, required. Experience should include all provider types with payers, government agencies and managed government plans
Current NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification, required
2 years of experience working with large payer or provider organization credentialing providers across multiple states, required
Ability to work in matrixed environment and manage competing tasks and assignments
Strong knowledge of the credentialing process including Primary Source Verifications
Benefits
Medical, Dental, Life, Vision + Option for HSA w/ Employer Contribution
401K with Match up to 4%
PTO: Accrual 4+ weeks/YR, buy-back program (get paid for unused PTO), and PTO donation program to allow Vivo team members to donate to others in need.
Wellness Reimbursement Program - $360 Annually
Employee Referral Bonus - Uncapped bonus potential
Tuition Assistance Program
Employee Assistance Program (Employer-provided)
Short & long-term disability (Employer-provided)
& More
Company
Vivo Infusion®
Vivo Infusion® is a leading provider of accessible, affordable, and safe community-based infusion and injection care for patients suffering from compromised immune systems, infectious diseases, and other medical conditions.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Stephan S. Rodgers
Chief Executive Officer
Recent News
Home Health Care News
2025-01-10
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