About Us:

Comprehensive Primary Care (CPC) is a collection of twelve office locations offering primary care for every stage of life. We’ve been part of the communities we serve for years – and in some cases decades. Together we strive for healthy neighbors across northern Virginia, eastern Maryland, and the District of Columbia.

The idea behind primary care is to provide a go-to medical home for every patient. We operate much like the old-fashioned generalists of the past – but with a distinctly contemporary approach to medicine. Your CPC primary care providers work to get to know you, your medical history and your needs, and plays an important role as the key first contact in your wellness decisions.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity, and accountability.

Our Values:

• Make health care easily accessible and readily
• Maintain a welcoming environment for all
• Listen to and respect the unique needs of each patient
• Respond quickly and maintain open, multi-level communication with each patient
• Encourage whole families, extended families and friends to take charge of their health
• Provide consistent high-quality health care
• Invest in professional development for providers and staff
• Maintain a safe and supportive working environment for all

About the Role:

Under the supervision of the Practice Manager, the Credentialing Provider Enrollment Specialist administers the credentialing, re-credentialing and delegated processes related to payer provider enrollment (credentialing). The incumbent works independently to coordinate, develop, monitor, and maintain the credentialing/payor provider enrollment process for over 55 providers.

Essential Functions

Essential and other important responsibilities and duties may include, but are not limited to the following:

• Implements and oversees all activities related to licensed independent provider delegated credentialing.
• Implements and oversees all activities related to health professional’s payer credentialing and re-credentialing.
• Performs regularly scheduled audits of the payer credentialing files.
• Assists in developing payer credentialing policies and procedures.
• Maintains knowledge of HRSA, NCQA, and Joint Commission credentialing requirements.
• Monitors regulatory sources to stay informed of rapidly changing rules and regulations that relate to credentialing processes.
• Reviews and processes all payer credentialing applications.
• Analyzes and resolves file issues, tracks progress on the database, and produces weekly reports as requested by the Director of Patient Financial Services.
• Responds to provider inquiries received by any form of communication.
• Handles administrative meeting issues as required.
• Will carry out moderately complex, multi-step instructions, and makes appropriate independent decisions, as necessary.
• Maintains close contact with Patient Financial Services Department to provide updates on new hires, terminations, approvals from MCOs, and any other information the PFS department could need from payer credentialing, or vice versa.
• Maintains and updates the providers CAQH files, PECOS, NPPES and any other payer credentialing website as appropriate.
• Works closely with all the in-network payers’ credentialing contacts to ensure a streamline credentialing and enrollment process.
• Resolves areas of concern in accordance with UHC’s policies and procedures regarding professional behavior.
• Performs other duties as assigned.

FLSA: Exempt

Education/Experience (Minimum Requirements)

• Bachelor’s degree OR an equivalent combination of education and experience which provides the required knowledge, skills and abilities deemed sufficient to prepare the applicant to successfully perform the duties of the position.
• Five years of ambulatory physician payor credentialing OR an equivalent combination of education and experience which provides the required knowledge, skills and abilities deemed sufficient to prepare the applicant to successfully perform the duties of the position.
• CPCS certification required within the first year of employment.

Required Knowledge, Skills, and Abilities

• Effective verbal and written communication skills to communicate with providers, Managed Care Companies, and hospital personnel via phone, email and through prepared correspondence.
• Demonstrated creativity, flexibility, and goal-oriented ability.
• Ability to work independently in a team-oriented environment and interact well with individuals with diverse ethnic and cultural backgrounds and needs.
• Demonstrated oral and written communication skills.
• History of positive customer relations as demonstrated by supervisor recommendation.
• Ability to perform presentations and interact with many different levels of UHC leadership.
• Ability to work independently with minimum supervision.
• Demonstrated ability to effectively work and communicate with diverse populations.
• Demonstrated proficiency with business software (e.g. Microsoft Office Suite). Experience with database reporting.

Guidelines

The position abides by all rules and regulations set forth by applicable licensing and regulatory bodies and the UHC policies and procedures.

Internal and External Organizational Relationships

The position requires contact with staff at all levels throughout the organization. There are also external organizational relationships that may be part of the work of this individual.

Work Location: Rockville, MD/In person

Medical Clearance:

You must complete Comprehensive Primary Care’s medical clearance requirements, which include, but may not be limited to, evidence of Hepatitis B, Pneumococcal screen, and a Tuberculosis screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases.

Comprehensive Primary Care values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

We consider an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, paid time off, including vacation and holiday pay. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location.