Credentialing & Enrollment Analyst I

Job Title: Credentialing & Enrollment Analyst I

Location: Remote, but must reside in any of the following states: AR, FL, IL, IN, KY, MO, OH, PA, or TN

Travel: N/A

FLSA Status: Exempt, Salaried

Work Schedule: Monday - Friday, 8:00 a.m. - 5:00 p.m.

About Family Allergy & Asthma:

Founded in 1979, Family Allergy & Asthma is one of the nation’s leading allergy and asthma practice groups, serving patients across Arkansas, Florida, Illinois, Indiana, Kentucky, Missouri, Ohio, Pennsylvania, and Tennessee. With more than 100 allergists, we are dedicated to delivering high-quality, patient-centered allergy and immunology care. Our comprehensive services include:

• Allergy and asthma evaluation and treatment
• Environmental, food, and drug allergy testing
• Pulmonary function testing
• High-risk food challenges
• Sublingual immunotherapy
• Aspirin desensitization
• Food immunotherapy

Position Summary:

The Credentialing & Enrollment Analyst I role involves daily management of credentialing & enrollment processes for providers (physician, nurse practitioner & physician assistants) that are employed by Family Allergy MSO. The analyst collaborates directly with the providers, insurance companies, hospitals, and other related healthcare entities to ensure that all necessary documents are maintained accordingly, submitted to the various entities and participation of the provider is approved and/or active. This role ensures providers meet all regulatory and compliance requirements to be reimbursed for services billed to the insurance carriers.

Summary of Duties & Responsibilities:

• Communicate with new provider to obtain documentation necessary for credentialing & provider enrollment processes.
• Create/Update required credentialing/enrollment portals.
• Medical Licensure – ensure active medical licensure respect to provider assigned regions.
• Board certification – ensure active board certification for related provider specialty.
• Malpractice – complete malpractice application, obtain signatures submit to contact.
• CAQH, Availity, CMS Systems – Update will all current accurate related data.
• Provider Enrollment – Insurance Plan Participation; Complete provider enrollment applications.
• Ensure timely follow-up procedures, throughout enrollment process.
• Complete re-credentialing and revalidations requests prior to deadlines, ensure re-approval is achieved.
• Hospital Privileges – Work in step with provider and hospital medical staff office completing application processes.
• Initial privileges – Complete applications for physicians.
• Re-Appointments – Complete reappointment applications.
• Dues and Application fees – Submit requests for payment to accounting via MyStampli system or pay by credit card.
• Excel Spreadsheets – Update various related excel sheets related to assigned providers such as Provider Credentialing; Provider Enrollment Tracker; Onboarding Checklist; Provider Insurance ID/PTAN; Hospital Affiliations; Provider NPI/License/DEA; Government Plan Revalidation; Standard Roster Templates; Current Locations; Malpractice; RCM Claims issues.
• Maintain active list of providers with medical society/board memberships and process related dues/fees yearly.
• Work shared email box with team members and respond or complete requests related to assigned providers.
• Reminder System – Notifications routed to team via HER-Medical Management system. Review daily and complete requests as required.
• RCM – Claims issues - assist in resolving claims issues that are provider enrollment related, which involves communication with the various insurance companies.
• Work notifications from RCM related to Checks from carriers being sent to wrong “pay to” address.
• Special Projects - complete any special assignments requested by Sr. Analyst or Payor Relations Manager.
• Other duties as assigned.