Forte Health and Wellness is seeking an organized Credentialing Specialist to assist us with administrative tasks pertaining to out practitioners' credentialing. The Credentialing Specialist will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up to date files and assist health plan providers and customer with phone inquiries.

Duties and Responsibilities

• Processing initial credentialing and re-credentialing applications
• Screening practitioners' applications and supporting documentation to ascertain their eligibility Identifying discrepancies in information and conducting follow-ups
• Maintenance of internal and external databases (CAQH, PECOS, NPEES)
• Assisting customers with credentialing inquiries
• Responding to health plan providers inquiries
• Responsible for follow-up after submission to ensure that health plans appropriately processed the request, and that provider information shows correctly on the health plans website
• Audits Health Plan Directory CAQH creation and maintenance experience
• Medicare & Medicaid enrollment and revalidation
• Perform provider roster reconciliation
• Performs other administrative duties as assigned

Requirements and Qualifications

• A minimum of two to three years of experience in a medical office setting and 2 year of credentialing experience
• Understanding of medical and billing terminology.
• Must have experience with PC based business applications software such as Microsoft Office, Word and Excel.
• Must have a High school diploma or GED.
• Proper English grammar, usage, spelling and punctuation: modern business office procedures, including filing systems, business correspondence, and telephone techniques.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems. Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners and shredders
• Excellent communication skills for both phone contacts with insurance payers to resolve issues as well through correspondence with various companies.
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
• Problem-solving skills to research and resolve discrepancies
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Ability to multitask.

Job Types: Full-time, Part-time

Pay: $18.00 - $21.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Credentialing: 3 years (Required)

Work Location: In person