StrideCare
CREDENTIALING & ENROLLMENT SPECIALIST - ASC
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Description
Job Summary
The ASC Credentialing & Enrollment Specialist is responsible for managing the credentialing, recredentialing, and privileging process for healthcare providers within the Ambulatory Surgery Center and StrideCare medical groups. This role ensures that all providers maintain active and compliant credentials with health plans, ASCs, and regulatory entities.
Essential Functions
- Submit initial and reappointment applications to commercial, IPA & MCO Plans to ensure PAR and effective dates.
- Primary Source Verify state license, DEA, hospital affiliations, certifications, OIG, SAM, NPDB, and professional work history.
- Maintaining and updating CAQH profiles to ensure continuous payer compliance.
- Tracking license, certification, malpractice, and DEA expiration dates to ensure timely renewals.
- Ensure compliance with NAMSS, CMS, Joint Commission, AAAHC, and ASC bylaws for medical staff members.
- Ensure compliance with Federal, state, and payer-specific regulations.
- Track status of onboarding activities and provide updates to internal departments.
- Facilitate Initial and reappointment applications for acquisitions, medical group, and the ASC.
- Obtain and organize information and documentation pertinent to acquisitions, practices, and providers.
- Maintain Credentialing database ensuring up-to-date information.
- Act as a liaison between Healthcare organizations, commercial, and government payers to resolve onboarding and enrollment issues.
- Ability to multi-task in a fast-paced environment.
- Maintain the organization’s Payer Matrix.
- Work with RCM to identify denial trends related to credentialing or enrollment issues.
- Knowledge of Medicare, Medicaid, commercial, and government enrollment processes.
- Exceptional organization skills and attention to detail.
- Participating in special projects and completing other duties as assigned.
- Processing and tracking hospital appointment and reappointment applications for provider privileges.
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Qualifications And Education Requirements
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- MUST reside in AZ, CO, FL, GA, MD, OK, SC, TN, TX, or VA.
- High School Diploma or equivalent, CPCS preferred.
- 3+ years in the healthcare industry.
- Compliance with all HIPAA policies.
- Microsoft Office experience (Excel, Word, Outlook, PowerPoint).
- Excellent organization and communication skills.
- Handle multiple projects simultaneously in a fast-paced environment.
- Satisfactory criminal background check.
StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.
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