Credentialing Specialist

Company Description

Think Big Health Care Solutions is a health resource, consulting, and practice management company located in Wellington, FL. Our specialization is improving the financial success and sustainability of physician practices through various services such as revenue cycle and cash flow management, human resource support, compliance, operations, athenahealth™ project management, and business development. We have a strong focus on addressing operational challenges and maximizing financial and clinical performance.

Role Description

This is a full-time hybrid role for a Credentialing Specialist. The Credentialing Specialist will be responsible for conducting provider credentialing to insurance plans, contract acquisition, contract negotiation, and provider maintenance services for various plans and facilities. The role will also involve effective communication with clients and providing exceptional customer service.

Qualifications

• Credentialing and Medical Staff Credentialing skills
• Excellent communication skills
• Strong customer service orientation
• Knowledge of Medicare regulations
• Attention to detail and ability to multitask
• Experience in healthcare administration or related field
• Proficiency in relevant software and tools
• Certification in credentialing or related area is a plus

Duties and Responsibilities:

• Performs all aspects of credentialing activities to ensure effective operations, compliance with government/state regulations, and that all providers are appropriately credentialed
• Accurately and timely completes all applications providing accompanying documents for credentialing and re-credentialing of practitioners
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Processes requests for privileges accurately
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Monitors the initial, reappointment and the expirable process for all providers, ensuring compliance with regulatory bodies
• Performs miscellaneous job-related duties as assigned.
• Handles the review and analysis of provider applications and accompanying documents, ensuring applicant eligibility.
• Prepares credentials file for completion and presentation to Credentialing manager
• Performs miscellaneous job-related duties as assigned.
• Manage credentialing activities by gathering appropriate provider data, review due diligence documents and document all credentialing in appropriate files/records
• Manage assignments, work flow and establishes priorities on a daily basis
• Able to assist with contract acquisition and follow-up
• Escalate issues to the appropriate members of the credentialing team, and/or co-workers as necessary to problem solve matters through clear communications.
• Ensure proper follow up is completed ahead of deadlines

Job Type: Full-time

Benefits:

• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday