Credentialing & Enrollment Account Representative

Location:                 InteCare Administrative Offices, Indianapolis, Indiana

Reports to:             C&E Director Accounts

Supervises:            N/A

This is a Full-Time, Salaried, Exempt Position

Summary:

This is a salaried, full-time position with certain direct responsibilities key to the success of the organization. This crucial role in the organization serves as the primary contact and “face” of the company for all credentialing activities for assigned medical and/or behavioral organizations and/or group healthcare practitioners.  This position is responsible for the overall satisfaction of the client by maintaining contact with the client on a regular basis throughout the onboarding and continued service support processes. In addition, this position requires effectively coordinating and working with a team of experts to effectively deliver satisfaction to the client. 

Responsibilities Include: Primary contact for all assigned contracted organizations and/or groups; expertise in credentialing and enrollment processes, independently making decisions on behalf of the organization, completing enrollments for all providers with all payors, following up with payors for effective dates, assigning priorities to support staff, facilitating weekly, monthly, and/or quarterly meetings with clients.  Reporting of all activities and credentialing performance measures for the organization and InteCare.

Scope of Role/Principal Responsibilities

Develop relationships with the clients to understand their C&E needs, from hiring a new provider to claim denials.

Communicate clear expectations of credentialing and enrollment activities provided to organization liaisons.

Train organization liaison staff on credentialing and enrollment software and reports as needed.

Review and conduct analysis of credentialing status of all organization providers and locations with each payor.   

Initiate and request Medicare and Medicaid enrollment.

Enroll all providers with managed Medicaid, commercial and Medicare advantage plans contracted with the organization.

Ensure immediate response from payor inquiries and serve as Payor Liaison and contact for all assigned contracted organizations, which includes resolving credentialing issues in a timely, professional, and organized manner.

Provide consistent follow up with payors for credentialing status.

Ensure provider documentation and forms are saved according to the documentation structure for the group.

Ensure CAQH is up to date for all providers and provide attestations as required.

Lead regular client meetings to update the client on resolution of their credentialing issues and needs. Ensure minutes of meetings are provided to all participants.

Follow all Standard Operating Procedures and Quality Standards/Requirements

Ensure all provider information is accurately uploaded/entered into the InteCare database system.

Facilitate weekly, monthly, and/or quarterly meetings with the organization and report all activities related to the credentialing progress.

Ensure priorities are being met on behalf of the client, issues are being resolved, and the client is ultimately satisfied with the credentialing services.

Facilitate and assist as requested and/or per the contract with Payor contracting processes.

Provide oversite to all activities as required to update all applicable organization and group practitioners in a timely manner, this may include, but not be limited to, updating the organization and/or group entity status with the Payor; update locations and all applicable information; and terminate and credential all practitioners who had not previously been submitted for Payor participating provider Network status prior to contracting with InteCare.

Participate in required meetings including but not limited to; Credentialing and Enrollment Program Team meetings; billing meetings; quarterly InteCare staff meetings.

Assist with training and mentoring C&E staff as needed.  

All other duties as assigned.

Education requirements, Training, and Professional Licenses & Credentials:  Bachelor’s degree in health care, mental health care, health care administration related field, preferred or bachelor’s degree in other field/High School Diploma with 4 years credentialing experience.

Required or Preferred Prior Work Experience:  Experience with both medical and behavioral healthcare credentialing activities of at least 3 or more years; experience with working in a professional team environment; experience with public speaking and presentations.

Expected Professional Competencies & Skills:

Excellent verbal and written communication skills

Fundamental understanding of both medical and behavioral healthcare.

Excellent organization, time, and task priority management skills.

Excellent ability to work with a team.

Ability to delegate without direct supervisory duties.

Excellent knowledge in Microsoft computer applications including Excel, Word and Outlook

Knowledge of Adobe Pro and utilizing online tools (Chrome, saving favorites)

Thorough knowledge of health care insurance industry, including expectations of Private and Public Payors in the health care insurance industry.

Prior experience working in a professional environment.

Excellent documentation skills, including writing notes, meeting minutes, letters, reports.

Must be highly organized, efficient, works independently and diligent with follow up.

Working Conditions:

Primarily in Remote Setting

Travel as Required; Minimal