Provider Enrollment and Credentialing Specialist

We are seeking a detail-oriented and proactive Provider Enrollment and Credentialing Specialist to join our team. This role is essential in ensuring that healthcare providers are properly enrolled with insurance payers, credentialed according to industry standards, and compliant with all relevant regulations. The ideal candidate will possess strong organizational skills, healthcare software proficiency, and a thorough understanding of healthcare regulations to facilitate smooth provider onboarding and ongoing credentialing processes.

Duties

• Manage the enrollment process for new healthcare providers with various managed care organizations, government programs, and insurance payers, ensuring timely completion of all documentation.
• Maintain accurate and up-to-date provider records within healthcare databases and credentialing management systems.
• Verify provider credentials in accordance with industry standards such as NCQA (National Committee for Quality Assurance) and JCAHO (Joint Commission on Accreditation of Healthcare Organizations).
• Monitor compliance with CMS (Centers for Medicare and Medicaid Services) regulations and other federal or state healthcare policies.
• Coordinate with providers, insurance companies, and regulatory agencies to resolve enrollment issues or discrepancies efficiently.
• Track renewal deadlines for provider licenses, certifications, and insurance enrollments to ensure continuous compliance.
• Assist in preparing documentation for audits related to provider credentials and regulatory adherence.

Skills

• Extensive knowledge of managed care processes, health insurance policies, and healthcare regulation policies.
• Proven experience with CMS regulatory compliance, including Medicare and Medicaid enrollment procedures.
• Familiarity with healthcare software applications used for credentialing and database management.
• Strong understanding of medical terminology, state healthcare regulations, NCQA standards, and JCAHO accreditation requirements.
• Contract management experience within the healthcare sector is highly desirable.
• Excellent organizational skills with the ability to manage multiple priorities simultaneously.
• Effective communication skills to collaborate with providers, payers, and regulatory bodies professionally.

Excellent opportunity to join a medical aesthetics and wellness practice in the beautiful Stone Oak area of north San Antonio, Texas. Marcos Medical Care has been in business for 26 years. Please visit us at www.marcosmedical.com to learn more about us and the wide array of services we provide.