Provider Enrollment And Customer Service Specialist
**Internal Candidates only** Job Summary Under supervision, initiates the enrollment and credentialing process for District of Columbia health care provider applications and complies and processes data in compliance with program requirements. This position ensures thorough and timely verification of all provider credentials and application materials. This will include, but not be limited to, responsibility for credentialing new and established health care providers, and the maintenance of information including; primary source verification, provider follow-up, data collection, data entry, and document file review and provider update requests. Specialists are often the first point of contact with an applicant and influence their interest to join or remain in the network. Also responsible for taking calls from providers, answering provider inquiries, and processing phone and mail applications as needed. - Job Type: Full time - Reports to: Provider Enrollment and Customer Service Supervisor - Location: Washington, DC Duties and Responsibilities . Performs credentialing and re-validation activities for prospective and current District of Columbia providers according to established guidelines. Duties include; reviewing provider applications, applying policy and criteria based on provide type, performing source verifications and processing provider files. . Ensures provider compliance in regards to licensing and sanction information with all accrediting organizations and regulatory agencies . Maintain provider updates as requested, verifying data and entering information into MMIS. . Completes all documentation and data entry in a timely and accurate fashion. Follows regulation timeframes and procedural guidelines for processing applications, updates and disenrollment activities according to company and contract standards . Answer phone calls received through the project toll free number, responding to provider inquiries and assisting with completing applications . Responds to all provider enrollment related inquiries and requests in a timely and thorough fashion . Maintains professional interactions with providers, persistently following up on missing enrollment information and required documentation to complete file . Communicates to providers any regulations and certification changes that affect file maintenance or membership, obtaining necessary documentation from providers for processing . Communicates provider problems, inquiries or issues that cannot be resolved independently through the appropriate channels for resolution . Participate in identifying issues, developing alternatives, and implementing solutions to issues that impact operations . Ability to make determinations regarding applicable provider files to be elevated for additional review and/or escalation . Collects all pertinent documentation that supports escalation actions for Supervisor review . Communicate improvements to enhance systems development and processing capabilities . Perform other duties as assigned by management Education and Experience Requirements . Associate's Degree or High School Diploma and previous customer service experience . One to three (1-3) years of experience in healthcare credentialing (ie, healthcare facility, managed care setting, insurer, credentialing verification organization) . Bachelor's Degree from an accredited college or university or appropriate experience in a similar field . Excellent oral and writing skills, . Ability to successfully execute many complex tasks simultaneously . Ability to read and interpret written information from a variety of sources . Ability to work well under pressure in a fast-paced, deadline orientated work environment . Accuracy and attention to detail . Strong customer service orientation . Ability to establish and maintain relationships, building trust and respect by consistently meeting and exceeding expectations . Self-motivated with strong follow-through skills: Ability to work effectively both independently and with others Preferred Skills / Experience . Credentialing process and primary source verification knowledge . Knowledge and/or experience reviewing provider applications . Knowledge of public health care program provider enrollment and credentialing policies and procedures Company Description: HIT2 provides innovative solutions in health information management for the full lifecycle of healthcare finance and compliance operations. Our customized knowledge-based software helps manage healthcare costs. At the heart of HIT2 services are our technology competencies. Paired with our unparalleled process methods, these competencies deliver solutions and results that become an integral part of our clients success. HIT2's technical expertise can be leveraged for full system development, project management or staff augmentation. HIT2s areas of expertise include: SYSTEM DEVELOPMENT: Fully customized development from requirements to testing. ENTERPRISE CONTENT MANAGEMENT: System implementations for content management, digital assets, web content and record keeping. SYSTEM INTEGRATION: Expert integrations using open standards, APIs, and a comprehensive toolkit to seamlessly link applications. DATA WAREHOUSING & BUSINESS INTELLIGENCE: Data collection and analysis from multiple sources into a single access point portal that provides tools for key business functions.