Credentialing & Provider Enrollment Specialist

Job Description

Job Description

LOCAL CANDIDATES ONLY. Greater Philadelphia Health Action, Inc. (GPHA) is a cutting edge Joint Commission-Accredited healthcare organization and premier provider of primary medical, dental, and behavioral healthcare for more than 55 years. We are one of the largest ambulatory health centers in the region!

Because of our success and stability, GPHA has become an employer of choice, offering our employees competitive salaries and a full array of benefits and rewards to include performance bonuses, medical, dental, and life insurance, tuition reimbursement, paid-time-off, holiday pay, 401(k) with LUCRATIVE company match, and a collaborative work environment.

We are presently seeking a Credentialing & Provider Enrollment Specialist at GPHA’s Executive Offices located at Carl Moore Health Center in Southwest Philadelphia. Hybrid work schedule is available, but this position must work at least 3 days in the office to start, so we ask that candidates reside within a commutable distance to Philadelphia. LOCAL CANDIDATES ONLY.

The Credentialing & Provider Enrollment Specialist is responsible for credentialing, re-credentialing, provider enrollments and files maintenance for GPHA’s Licensed Independent Practitioners (LIP’s), and must ensure proper enrollment of all GPHA Dental (and potentially medical and behavioral health as may be required) providers into the various payer programs, noting that most dental provider enrollments into our plans are facilitated via CAQH, but some dental plans, including Delta Dental, Dentemax, Dominion Dental, and UHC (United Healthcare) Dental may still require manual applications, so must expertly facilitate these as well. Credentialing & Provider Enrollment Specialist must also manage provider numbers for all GPHA providers and locations, perform ALL duties associated with the daily responsibilities of the various Managed Care programs to ensure ALL providers’ files are kept up to date, and that they are enrolled (credentialed) properly, and re-credentialed properly in ALL plans with no delays or lapses as a participating provider. The Credentialing & Provider Enrollment Specialist must also always provide excellent customer service and use appropriate language in ALL Communications.

Successful candidates will have at least two to four years of college education plus a minimum of two years’ credentialing experience in a Health Center environment (or Managed Care Organization (MCO)), with a detailed understanding of provider enrollment and payment processes. Good computer and analytical skills. Good interpersonal and communication (both written and verbal) skills required. Again, Local Candidates only, please.

GPHA is an Equal Opportunity Employer. GPHA does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, age, handicap, disability, religion, religious creed, ancestry, national origin, or any other basis prohibited by applicable law.