Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Lead and supervise credentialing support staff, ensuring quality, accuracy, and timely processing of credentialing and enrollment tasks.
Oversee provider credentialing, licensure, and internal enrollment with Medicare, Medicaid, Managed Care, and Commercial Plans.
Maintain provider rosters, monitor license and certification renewals, and ensure compliance with regulatory and internal standards.
At Better Life Partners, we provide what it takes to heal from addiction. Wherever. Whenever. By combining virtual and in-person counseling, community support, and medication access.
Ensuring providers are credentialed in a timely manner by monitoring the submission process.
Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
Communicating with payors and conducting regular reviews to validate internal credentialing data.
Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.
Accountable for making decisions supported by policy based on confidential financial information both from the facility and from patients to determine qualification for CICP, Charity programs, or payment arrangements.
Verify coverage and authorization for all scheduled procedures through scheduling and registration information.
Act as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit is accessible to nearly one out of every four U.S. residents. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.
Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Coordinate care between VA and community providers.
Schedule appointments and coordinate care.
Process administrative notes for consults.
CVP is an award-winning healthcare and next-gen technology and consulting services firm solving critical problems for healthcare, national security, and public sector clients.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Responsible for accurately and respectfully responding to inquiries from employees/members, providers and clients in a high volume call center.
Seamlessly navigate multiple system applications/screens and resources to accurately respond to inquiries.
Thoroughly and accurately document all inquiries and actions taken using applicable software applications.
Luminare Health helps clients and brokers design custom self-funded healthcare plans providing innovative solutions, flexibility, complete data transparency, and member-centered support. They rely on their decades of industry experience and proven, data-driven results to deliver optimal benefits solutions, customized to meet our clients’ needs.
Manage all aspects of provider licensing, credentialing, and payer enrollment.
Coordinate end-to-end licensing workflows and maintain accurate records.
Act as a key liaison between clinicians, state boards, payers, and internal stakeholders.
They are committed to providing safe, discreet medication abortion treatment and offer a range of reproductive and sexual health care services. The in-house clinical care team composed of board-certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away.
Manage the day-to-day tasks of processing provider credentials, licenses and payor enrollment applications.
Work cross-functionally with many teams to guarantee the smooth running of operations.
Research, interpret, and evaluate information relevant to provider licensure and continuing medical education in the United States
CertifyOS is building the infrastructure that powers the next generation of provider data products, making healthcare more efficient, accessible, and innovative.
Manage prior authorizations and related administrative paperwork.
Input patient information, medical records (CPT, ICD-10, HCPCS), and billing data into EMR/EHR systems.
Assist with processing insurance claims, verifying patient insurance information, and handling billing inquiries, concerns, and documentation.
Wing is redefining the future of work for companies worldwide. They aim to be a one-stop shop for companies looking to build world-class teams and place their operations on autopilot.
Oversee the operations of the Imagine Pediatrics Onboarding, Credentialing, Licensing, and Enrollment Department. Develop and train on policies and procedures, workflows, and training documentation for the team. Manage Delegated Credentialing arrangements - implementation and audit – as well as ongoing Delegated partnerships with health plans.
Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Address the needs of patients with a focus on customer support, coordination of logistics, and problem solving.
Schedule and coordinate the flow of work within or between departments to expedite project efficiencies and resolution to escalations.
Address and resolve assigned inquiries with a sense of urgency; Ensure timely closure of escalation cases using email, phone, or salesforce.com
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other.