Provider Enrollment/Credentialing Specialist

Become a part of EMI Health’s growing organization. EMI Health is an employee benefits firm providing insurance products to companies and individuals in many states across the country. We provide our employees with an outstanding benefit package that includes paid medical and dental coverage for employees, paid time off, holiday pay, vision, life, disability, HSA and retirement savings plans.

We are a tobacco free workplace, hiring non-tobacco users only.

EMI Health is an EEO employer as defined by the EEOC.

SUMMARY: Under the direction of the Sr. Provider Relations Representative, the Provider Enrollment/Credentialing Specialist updates and maintains provider files and resolves claims in relation to provider maintenance issues. This position assists in the development and maintenance of, medical, dental, and other participating provider networks, following company procedure This is a full-time, non-exempt position located in Phoenix AZ. Hours are 8:00 a.m. to 5:00 p.m. Monday through Friday.

PRIMARY RESPONSIBILITIES:

ž  Updates and maintains provider databases, adds affiliations, and updates address lists.

ž  Resolves claims in relations to provider enrollment issues.

ž  Communicates with providers by phone and through written correspondence to resolve provider enrollment issues and to secure supporting documents for creating and maintaining provider records.

ž  Works with other departments to fulfill requests for changes or additions to provider records.

ž  Inputs data using database software on a personal computer.

ž  Documents the claims system for routing provider issues to other departments.

ž  Assists in 1099 process.

ž  Verifies required credentials to determine eligibility of participating providers and accuracy of records.

ž  Communicates with providers by phone and works with internal staff to resolve outstanding credentialing issues.

ž  Prepares written communication for credentialing providers.

ž  Actively participates in activities of the department to ensure compliance with overall objectives.

ž  Other duties as assigned.

EDUCATION, EXPERIENCE AND QUALIFICATIONS:

ž  High school diploma or general education degree (GED); plus six months related experience and/or training; or equivalent combination of education and experience. 

ž  Moderate/advanced Microsoft Excel skills.

ž  Excellent organizational skills.

ž  Effective written and verbal communication skills.

ž  Proficient with computer keyboard including ten key. (typing skills of 50 wpm., ten key skills 8,000 KPH)

ž  Ability to work independently, prioritize and organize workload.

ž  Ability to problem solve.

ž  Self-motivated and able to function in a team environment