QSM Health Systems, Inc
Provider Enrollment Specialist (Finance)
Assembles and maintains current and accurate data for all practices and providers.
Ensures timely processing of all credentialing requests.
Coordinates with providers to obtain signatures and documents necessary for completion of process.
Completes practice and provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
Ensures practice demographic and addresses are current with health plans, agencies and other entities.
Ensures Billing Team is aware of when a provider is enrolled with insurances via email.
Assists Billing Team with troubleshooting accounts with contract related issues.
Maintains a spreadsheet detailing which insurance practice and providers are credentialed with.
Communicate credentialing status to Providers, Department Mgrs. and COO
Assist provider with obtaining medical/professional licenses multiple states.
Remain current with Medical Nursing Board Act
Ensures all providers are in compliance with their respective state laws. Create and update protocols and coordinate Quality Improvement Evaluation (QIE) conferences and maintain reports.
Create and keep up with all provider's Council for Affordable Quality Healthcare (CAQH) profiles, attesting quarterly.
Order correct malpractice insurance, maintaining certificate information current as providers are hired or resigned.