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