Description:

The Payer Credentialing Specialist is responsible for overseeing the credentialing and enrollment process for healthcare providers and facilities with multiple insurance companies and payers. This role requires compliance with regulatory requirements and payer guidelines while maintaining accurate and up-to-date provider information in the organization's database.

Facilitate the credentialing and re-credentialing processes for healthcare providers, including physicians, nurses, and allied health professionals.

Collect, review, and verify all necessary documentation and information required for credentialing, such as licenses, certifications, education, training, and work experience.

Conduct primary source verification to ensure the accuracy and authenticity of provider credentials.

Coordinate and communicate with healthcare providers, professional organizations, licensing boards, and insurance companies to obtain and verify credentialing information.

Prepare and submit credentialing applications and supporting documentation to insurance companies, hospitals, and other relevant entities.

Monitor and track the progress of credentialing applications, follow up on any delays or outstanding requirements, and escalate issues as needed.

Maintain accurate and up-to-date provider credentialing files and databases.

Stay current with industry standards, regulations, and guidelines related to provider credentialing and ensure compliance.

Assist with audits, accreditation processes, and quality improvement initiatives related to provider credentialing.

Skills:

Credentialing, Provider relations, Medtrainer

Top Skills Details:

Credentialing,Provider relations

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.