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Credentialing Enrollment Coordinator in Miami, FL at Health Choice Network, Inc.

Date Posted: 5/31/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Miami, FL
  • Job Type:
    Management
  • Experience:
    Not Specified
  • Date Posted:
    5/31/2018

Job Description

Health Choice Network is committed to provide exceptional customer service that exceeds the expectation of those we service.  Each and every employee at HCN is expected to possess the ability to inspire confidence, display a constructive attitude, make ethical business decisions, and represent the company well in all aspects of customer service.


Duty Statement:The Credentialing Enrollment Coordinator isresponsible for accurately and timely processing all providers’ Medicaid and/orMedicaid and re-validation applications and credentialing & re-credentialingapplications received from contracted member FQHCs in accordance with CMSguidelines, applicable regulatory, statutory, or other CMS issued instructions.


Position Responsibilities:

  • Monitorsthe initial and re-credentialing process for all medical staff, Allied HealthProfessional staff, Other Health Professional staff, and delegated providers,ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS,federal and state).
  • Complete,review, and analyze the provider credentialing applications and accompanyingdocuments
  • Uploadprovider and/or site applications and documentation to respectiveMedicaid/Medicare Web Portal
  • Identifyissues that require additional investigation and evaluation, validatesdiscrepancies and ensures appropriate follow up
  • Setupand maintain provider information in online enrollment databases and systemsfor Medicare and Medicaid
  • Notify membercenters, revenue cycle management and internal staff, and other stakeholders asapplicable when an enrollment has been completed.
  • Monitor providerenrollment with Medicare/Medicaid and MCO’s to ensure proper participation date and
  • Reviewreports generated from provider data Management software (Echo) ofparticipating Medicaid and Medicare enrolled providers whose enrollment are inprocess
  • Maintaincurrent knowledge on state Medicaid and CMS Medicare rules, regulations andstate updates regarding the Medicaid program, and communicate any changes tothe Medicaid program to department leadership and center liaison
  • Servesas a resource for member centers with questions regarding state Medicaid andMedicare enrollment process and status.
  • Submitaddress change updates and other enrollment updates to the state and CMS asneeded
  • Fieldphone calls from provider offices regarding the Medicaid/Medicare enrollmentprogram, process for enrollment, and denied claims due to lack of activeenrollment in the program
  • Completeprovider re-validation as requested by the state to ensure participating providersmaintain enrollment in state Medicaid.
  • Additional duties may be assigned.
    Knowledge, Skills and Abilities Required for this Position to be Successful:
  • Knowledgeof Medicare and Medicaid enrollment process
  • Highlyorganized individual with excellent attention to detail and a great sense ofurgency.
  • Effectivecommunication and interpersonal skills and excellent Customer Service skillsincluding telephone conversations and face-to-face.
  • Exceptionalplanning, time management, problem solving and logical troubleshooting computerskills.
  • Knowledgeof Healthcare and/or Community Health Center industry and practices.
  • Analyticaland computer skills.
Education and Experience:

5years of healthcare experience and/or High School Diploma or equivalentcombined experience
Graduateof an accredited college or university with at least an Associate’s degree and aminimum of three years’ experience in a related position preferred
Priorcredentialing knowledge preferred

Health Choice Network is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.

HCN is a drug-free workplace.