Credentialing Specialist

Location: Oak Park, IL, 60302

Come join our large and growing medical group! We are looking for a dynamic and motivated full-time Credentialing Specialist. In this role, you will own the credentialing process end-to-end including tracking, file review, issue resolution, and roster auditing. Essential functions include all aspects of medical provider credentialing, management of provider records, as well as the following:

• Coordinates on-boarding process for new providers
• Compiles and maintains current and accurate data for all providers for all service locations
• Completes provider payer enrollment applications; monitors applications and follows-up as needed
• Completes physician credentialing applications and obtain appropriate signatures. Handles re-credentialing as needed.
• Follows all appropriate requirements set by the State of Illinois.
• Maintains copies of current state licenses, DEA certifications, malpractice coverage and any other required credentialing documents for all providers
• Maintains knowledge of current health plan and agency requirements for credentialing providers
• Sets up and maintains provider information in credentialing databases and systems
• Tracks license and certification expirations for all providers to ensure timely renewals
• Ensures practice addresses are current with health plans, agencies, and other entities
• Audits health plan directories for current and accurate provider information
• Maintains confidentiality of provider information
• Provides credentialing and privileging verifications
• Monitors credentialing process and regularly follows up with third party payors
• Relays information to management and billing department.
• Builds and maintains professional relationships with third party payors. Position also includes aspects of claim research and resolution to escalated claim issues.
• Researching and resolving claim issues as related to non-payment

Knowledge, Skills and Abilities:

• Knowledge of office administrative procedures.
• Skills in problem analysis and problem resolution.
• Skills in computer applications.
• Skills in oral communication.
• Skills in planning and organizing.
• Ability to communicate clearly.
• Ability to multi-task.
• Ability to work pleasantly and efficiently with co-workers.
• Ability to maintain a high level of confidentiality.
• Ability to adapt to changes in work environment.
• Ability to operate most standard office equipment.

Experience: Credentialing, preferably in a medical office setting with the above areas of responsibilities. Credentialing software experience a plus.

Education:

• High school or equivalent (Required)
• Credentialing Certification – Preferred, but not required