Job Posting for Credentialing Specialist at InStride Foot & Ankle Specialists
The Credentialing Specialist will ensure that appropriate processes are in place to monitor and maintain systematic, timely credentialing and re-credentialing of network providers. Performs a meticulous review of health provider’s qualifications, Submits the information with necessary applications to insurance companies and other payers.
Essential Duties and Responsibilities
Initiate and complete the provider enrollment credentialing and recredentialing process for physicians.
Assist providers in completion of various applications for managed care participation.
Ensure provider practice addresses are current with health plans.
Update and provide quarterly rosters to payers in accordance with their policies and procedures.
Audit health plan directories for current and accurate provider information.
Maintain timely and accurate data entry of provider data in CAQH.
Monitor expiring licensure, board and professional certifications and other documents that expire for all providers and ensure timely renewals.
Assist in trouble-shooting provider plan participation interruptions and other member related issues.
Assist and maintain internal fee schedules for North and South Carolina.
Adhere to policies and procedures including data security, confidentiality and timely delivery of completed work.
Other duties as assigned.
Requirements
2-3 years of credentialing experience
Ability to meet deadlines and prioritize.
Knowledge of provider credentialing requirements
Ability to manage multiple projects effectively.
Ability to analyze, interpret and synthesize a wide range of information, including legal and contract language, policies, standards and guidelines.
Represents the office/Organization in a positive manner.
Possess analytical and problem-solving skills.
Must maintain patient/client confidentiality.
Physical Requirements Must be able to sit for long periods of time and work in a fast-paced office environment. Should be able to bend and lift up to 10 lbs.
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