The Role
The Provider Enrollment Specialist manages the credentialing and re-credentialing processes for healthcare professionals, ensuring compliance with regulatory standards and maintaining accurate provider records.
Summary Generated by Built In
Pinnacle Wound Management is a leading wound care provider dedicated to delivering high-quality patient care. We are seeking a detail-oriented Provider Enrollment Specialist to join our team. This role is critical in ensuring our healthcare professionals meet all necessary licensing, certification, and regulatory requirements.
As a Provider Enrollment Specialist, you will be responsible for managing the credentialing and re-credentialing process for all of our physicians and mid-level healthcare providers. You will maintain accurate records, verify professional credentials, and ensure compliance with industry regulations and accreditation standards.
If you are a meticulous and organized professional with a passion for healthcare compliance, we want to hear from you! Apply now to join us in ensuring the highest standards of wound care excellence!
Key Responsibilities:
- Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirements
- Complete and track initial and re-credentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care Organizations
- Assist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbers.Monitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelines
- Manage termination of payer enrollments for providers leaving the organization
- Provide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entities
- Collaborate with the Director of Operations to ensure timely credentialing and re-credentialing of all providers.
- Track and ensure the renewal of state DEA licenses, board certifications, and malpractice insurance
- Identify and resolve potential onboarding issues, offering solutions to streamline the credentialing process
- Maintain records of all managed care contracts and ensure portal logins remain active.Ensure compliance with relevant accrediting and regulatory agencies
- Monitor trends and recommend improvements to credentialing workflows
Requirements
Benefits
- 401k
- 401k matching
- Competitive pay
- Medical, dental, and vision insurance
- Paid time off
- Free parking
- No nights, no weekends
- Monday - Friday, 8 hour shift
Skills Required
- High school diploma or equivalent; credentialing certificate preferred
- Minimum of 5 years experience in physician credentialing or related field
- Knowledge of credentialing standards and healthcare regulations
- Proficiency in credentialing software and Microsoft Office Suite
- Strong attention to detail, organizational, and problem-solving skills
- Excellent written and verbal communication skills
- Ability to work independently and manage multiple tasks efficiently
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The Company
What We Do
Pinnacle Wound Management is a U.S.-based specialty wound care company that provides comprehensive management solutions, including bedside and telemedicine wound consultations, to long-term care settings.
