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    Client Services Representative - Oklahoma, United States - Harris Computer Systems

    Harris Computer Systems
    Harris Computer Systems Oklahoma, United States

    3 weeks ago

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    Description

    The Enrollment and Credentialing Specialist plays a crucial role in ensuring that individuals and healthcare providers are properly enrolled and credentialed with insurance companies, government agencies, and other healthcare organizations.

    This position requires a detail-oriented individual with strong organizational and communication skills to handle the administrative tasks associated with the enrollment and credentialing processes.


    Enrollments:

    • Manage the enrollment process for healthcare providers, including group practices, physicians, other healthcare professionals.
    • Gather and submit necessary documents, such as applications, licenses, certifications, and insurance information.
    • Ensure that all enrollment forms are completed accurately and in a timely manner.
    • Liaise with insurance companies, government agencies, and other healthcare organizations to facilitate the enrollment process.
    • Monitor the status of enrollment applications and follow up as needed to ensure timely completion.

    Credentialing:

    • Coordinate the credentialing process for healthcare providers, ensuring compliance with regulatory requirements and organizational policies.
    • Collect provider information, such as education, training, work history, and professional references.
    • Review and analyze credentialing applications and supporting documents for accuracy and completeness.
    • Communicate with providers and external organizations to obtain missing or additional information as necessary.

    Database Maintenance:

    • Maintain accurate and up-to-date provider enrollment and credentialing databases.
    • Enter and update provider information, ensuring data integrity and confidentiality.
    • Generate reports and track the status of enrollments and credentialing processes.
    • Maintain accurate provider profiles for State Medicaid, CAQH, PECOS and NPPES portals

    Compliance:

    • Stay updated on relevant laws, regulations, and accreditation standards related to enrollment and credentialing processes.
    • Ensure compliance with applicable regulatory requirements, including HIPAA and other privacy regulations.
    • Assist with internal and external audits, providing necessary documentation and supporting materials.

    Communication and Collaboration:

    • Serve as a primary point of contact for providers regarding enrollment and credentialing inquiries.
    • Collaborate with internal departments, such as Revenue Integrity and RCM leadership to gather necessary information and resolve issues.
    • Build and maintain positive relationships with insurance companies, government agencies, and other external stakeholders.

    Qualifications and Skills:

    • High school diploma or equivalent
    • Prior experience in enrollment and credentialing processes within a healthcare setting.
    • Strong knowledge of healthcare industry regulations, such as HIPAA, Medicare, and Medicaid.
    • Excellent attention to detail and ability to maintain accuracy while handling multiple tasks.
    • Proficient computer skills, including experience with database management and Microsoft Office Suite.
    • Exceptional organizational, communication, and interpersonal skills.
    • Ability to work independently and as part of a team in a fast-paced environment.
    • Strong problem-solving and decision-making abilities.
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