JOB TITLE: Credentialing Specialist ? Remote
FLSA STATUS: Exempt
REPORTS TO: Vice President of Intergration
Job Overview
The Credentialing Specalist is responsible for organizing, maintaining, and verifying all aspects of the credentialing process for supported doctors. Maintain active status for all providers by successfully completing initial credentialing and re-credentialing of providers with insurance companies, state and federal payors, and other third-party payors.
Key Responsibilities:
This job will be expected to complete the following functions. This is not an all-inclusive list. This job may be assigned other functions or tasks. This is meant to be a general description of the most essential functions only.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing application
Establish and maintain positive relationships with payors.
Support all new doctors by completing all verifications and required paperwork
Complete audits for delegated companies
Maintain accuracy of files by tracking expiration of licenses and certifications
Maintain up-to date knowledge and understanding of insurance plans and Medicaid
Maintain internal provider spreadsheet to ensure all information is accurate and logins are available
Update each provider?s CAQH database according to the schedule published by CMS
Maintain and monitor active provider licenses; Professional, DEA, Controlled Substance etc.
Complete revalidation requests issued by government payers
Complete/manage credentialing applications to add providers to commercial payers, and Medicaid
Complete/manage re-credentialing applications for commercial payers
Work closely with Insurance Coordinator to identify and resolve any denials or authorization issues related to provider credentialing
Maintain accurate provider profiles on CAQH, DOSSIER, PECOS, NPPES, and CMS databases
Create and manage work order for the CTM
Create all necessary files for offices to have a smooth transition new TIN
Other duties as assigned
Requirements (Education, Certifications, Knowledge, Skills, and Abilities):
High School Diploma or GED
Minimum 2 years credentialing experience
Understand provider credentialing and its direct impact on the practice?s revenue cycle
Excellent computer skills including Excel, Word, and Internet use
Detail oriented with above average organizational skills
Ability to plan and prioritizes to meet deadlines
Self-motivated and capable of working remotely.
Ability to function well in a fast-paced environment.
Benefits:
Medical, Dental, Vison, Life insurance, short term Disability
Paid Time Off and Holidays
401K
Strong culture of patient care and experience
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