Job Type Full-time, Contract Description
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:
1. Manage the full cycle of provider credentialing with insurance carriers
2. Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications and facility privileging
3. Maintain credentialing software to ensure all information is accurate and updated
4. Update each provider’s CAQH database file timely according to the schedule published by CMS
5. Coordinate with Divisions on the application for and renewal of all provider licenses; Professional, DEA, Controlled Substance, etc.
6. Collaborate with Divisions to obtain all provider data as relates to credentialing and privileging
7. Manage revalidation requests issued by government payers
8. Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
9. Complete re-credentialing applications for commercial payers and facilities
10. Credential new providers and current providers with facilities at which they hold staff privileges
11. Work closely with the CBO and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
12. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
13. Maintain updated OCC/Divisional provider rosters and review biannually with major payers
14. Establish and maintain relationships with payers and adhere to all payer credentialing requirements
15. Develop and maintain policies and procedures related to credentialing and privileging
16. Develop and maintain Onboarding/Provider forms
17. Provide Quarterly education to Division and Billing leaders
18. Other duties as assigned
Requirements
REQUIRED QUALIFICATIONS AND SKILLS:
19. Minimum of 4 years’ experience in medical practice business office role
20. Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
21. Highly (above average level) detail oriented with excellent follow through to see tasks to completion
22. Excellent computer skills including Excel, Word and Internet / Cloud based technology
23. Strong and clear written and verbal communication skills
24. Excellent customer service skills
25. Possesses a high degree of self-motivation and produces high quality work with minimal supervision
DESIRED QUALIFICATIONS AND SKILLS:
26. 2 years’ experience in provider credentialing
27. 2 years of college level education
PAY & BENEFITS:
$23.00 - $26.00 per hour
28. Medical, Dental and Vision Insurance
29. Generous PTO package and paid holidays
30. Company-paid life insurance and long term disability insurance
31. Ability to purchase accident insurance, short and long-term disability insurance.
32. Opportunities for internal training and development
33. Annual stipend for continuing education in certain positions
34. Retirement Plan eligibility after one year of service with eligibility in company profit sharing
35. Most positions offer Monday – Friday work schedules
Salary Description $23.00 - $26.00