Credentialing Specialist $15-$17/hr DOE

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Job description

Description:

Description

Credentialing Specialist job outline:

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required.

Responsibilities and Duties:

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing and re-credentialing applications.

• Compiles and maintains current and accurate data for all providers.

• Update each provider's CAQH database file timely according to the schedule published by CMS.

• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

• Complete re-validation requests issued by government payers.

• Maintains corporate provider contract files.

• Maintains knowledge of current health plan requirements for credentialing providers including managing delegated health plans.

• Ensures practice addresses are current with health plans and contracts as needed.

• Applying for in-network contract with various insurance carriers.

• Maintains confidentiality, security, and physical safety of any Provider, Plan, and PHI data.

• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.

• Work closely with the Revenue Cycle Director 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.

. Requirements:

Requirements

Required/Preferred Qualifications:

• High school diploma/equivalent and 1-2+ years of Healthcare Credentialing experience.

• Knowledge and understanding of credentialing and re-credentialing processes.

• Must possess a strong proficiency with Microsoft Office Suite (Word/Excel/Outlook/PowerPoint).

• Medical Terminology.

• Strong knowledge of billing including rules and regulations.

• Must have knowledge with Credentialing databases such as (AHCA, CAQH, NPPES, PECOS, etc).

• Strong knowledge of Medical Contracts and negotiating.

• Excellent interpersonal, verbal, written and customer service skills, with attention to accuracy and detail. Must be personable, well organized and maintain a high level of professionalism.

• Must have the ability to follow instructions, work under deadlines, complete tasks unsupervised, prioritize, multi-task and be proactive.

• Versatile, flexible, and willing to work within a dynamic environment.

PM20

PI