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Credentialing Enrollment Specialist

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Advocate Health Care

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Location:
United States , Charlotte

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Category:
Office Administration

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Contract Type:
Not provided

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Salary:

24.10 - 36.15 USD / Hour
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Job Responsibility:

  • Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers
  • Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office
  • Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants
  • Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner
  • Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities
  • Conducts practice site visits for practices within MGD
  • Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System
  • Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation
  • Provides Team member support to the CPN Credentialing and Quality Review Committee

Requirements:

  • High school diploma or GED required
  • Bachelor's degree preferred
  • Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment
  • Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone
  • Experience in typing, word processing, and business correspondence
  • Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred
What we offer:
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

Additional Information:

Job Posted:
January 29, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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