Credentialing Specialist jobs in Rockford, IL

Sandwich, IL FULL_TIME

Aishling Obstetrics & Gynecology is looking for a dynamic and motivated full-time Credentialing Specialist with Medical Billing experience.

In Essential functions of this role include, the credentialing process end-to-end including tracking, file review, issue resolution, and roster auditing.

• 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 obtains 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.
• Insurance payment posting
• Insurance claim follow-up
• Required knowledge of CAQH, NPPES, PECOS, AVAILITY, Impact and other electronic applications

Experience :

• Credentialing, preferably in a medical office setting with the above areas of responsibilities.
• Credentialing software experience a plus.
• Microsoft Office : 1 year (Preferred)
• Microsoft Word : 1 year (Preferred)
• Knowledge of EOB interpretation
• Knowledge of CPT, HCPCS, and ICD-10 coding guidelines

Last updated : 2024-03-31