Funciones y responsabilidades:

Provider/Credentialing Management:

• Manage the health plan enrollment process for new current and new healthcare providers, including gathering necessary documentation and completing applications for various insurance networks and government programs (e.g., Medicare, Medicaid).
• Review and maintain provider data in the enrollment database, ensuring all information is current and accurate for billing and credentialing purposes.
• Conduct thorough credentialing and recredentialing processes for healthcare providers.

Health Plan Enrollment Coordination:

• Facilitate the enrollment of providers into health plans, including the completion and submission of necessary documentation.
• Maintain up-to-date records of provider enrollment statuses and ensure timely processing.

Data Management:

• Utilize credentialing software and databases to manage provider information efficiently.
• Perform regular audits of provider files and databases to ensure accuracy and completeness.
• Maintain accurate provider records in the database, ensuring all information is current and compliant with regulatory standards.

Communication:

• Act as the primary point of contact for providers regarding health plan enrollment and inquiries.
• Collaborate with internal teams, including billing, and Human Resources to streamline processes.

Regulatory Compliance:

• Stay updated on changes in health plan enrollment regulations and credentialing standards.
• Assist in preparing documentation for audits and regulatory reviews.

Training and Support:

• Provide guidance and training to new staff on credentialing processes and systems.
• Support providers in navigating enrollment challenges and requirements.
• Identify opportunities for streamlining the enrollment process and implement best practices to enhance efficiency.

Focus on Corporate Expectations/Standards:

• Attends and actively participates in all meetings (e.g., team meetings, department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
• Works flexible or extended hours where necessary.
• Demonstrates awareness of, and compliance with, organizational mission and objective of Camarena Health to provide health care access and support services for all members of the community.
• Other work-related duties as assigned by supervisor; duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
• Maintains confidentiality and respect for information regarding providers. abides by Camarena Health Rules of Confidentiality