Credentialing Specialist

POSITION OVERVIEW

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.

ESSENTIAL FUNCTIONS:

• Manage the full cycle of provider credentialing with insurance carriers
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications and facility privileging
• Maintain credentialing software to ensure all information is accurate and updated
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Coordinate with Divisions on the application for and renewal of all provider licenses; Professional, DEA, Controlled Substance, etc.
• Collaborate with Divisions to obtain all provider data as relates to credentialing and privileging
• Manage revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers and facilities
• Credential new providers and current providers with facilities at which they hold staff privileges
• Work closely with the CBO and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Maintain updated OCC/Divisional provider rosters and review biannually with major payers
• Establish and maintain relationships with payers and adhere to all payer credentialing requirements
• Develop and maintain policies and procedures related to credentialing and privileging
• Develop and maintain Onboarding/Provider forms
• Provide Quarterly education to Division and Billing leaders
• Other duties as assigned

REQUIRED QUALIFICATIONS AND SKILLS:

• Minimum of 4 years’ experience in medical practice business office role
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Highly (above average level) detail oriented with excellent follow through to see tasks to completion
• Excellent computer skills including Excel, Word and Internet / Cloud based technology
• Strong and clear written and verbal communication skills
• Excellent customer service skills
• Possesses a high degree of self-motivation and produces high quality work with minimal supervision

DESIRED QUALIFICATIONS AND SKILLS:

• 2 years’ experience in provider credentialing
• 2 years of college level education

PAY & BENEFITS:

$23.00 - $26.00 per hour

• Medical, Dental and Vision Insurance
• Generous PTO package and paid holidays
• Company-paid life insurance and long term disability insurance
• Ability to purchase accident insurance, short and long-term disability insurance.
• Opportunities for internal training and development
• Annual stipend for continuing education in certain positions
• Retirement Plan eligibility after one year of service with eligibility in company profit sharing
• Most positions offer Monday – Friday work schedules