Credentialing Specialist

About Exact Billing Solutions 

At Exact Billing Solutions, we pride ourselves on our outstanding commitment to providing efficient, exact and quality medical billing to our customers. We are a team of professionals in the medical billing field with a specialty in the substance abuse and mental health fields of health care services. We have extensive industry knowledge, an understanding of the specific challenges of this market and we stand by our commitment to offer outstanding services to our clients. At Exact Billing, we use up to date software to meticulously track every claim. 

Brief description 

The Credentialing Specialist is responsible for all aspects of contracting facilities with the insurance companies, credentialing, re-credentialing and applications for contracting. Credentialing specialist ensure that facilities and physicians are following regulations and maintain all records related to insurance contracts and staff credentials. Communication skills are essential, since the role involves coordination between the facilities and the insurance companies in contract negotiation. A person must have good organizational skills to track many contracts at once. The Credentialing Specialist reports to the Director of Billing. 

Tasks  

• All aspects of contracting with insurance companies 
• Compiles and maintains current and accurate data for all providers 
• Completes facility and provider credentialing and re-credentialing applications 
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required documents for facility and providers 
• Maintains insurance contracts 
• Maintains knowledge of current health plan and agency requirements for contracting and credentialing providers 
• Maintains and sets up facility and provider information on online credentialing databases and system. 
• Tracks license and certification expiration's for facility and providers. 
• Ensures facility address are current with health plans and other entities. 
• Processes application and follow-up for contracting with insurance companies. 
• Audits health plan directories for current and accurate facility and provider information. 
• Other duties as assigned by Billing Director.  

Qualifications/Skills  

• Knowledge and understanding of the credentialing process 
• Ability to organize and prioritize work and manage multiple priorities 
• Verbal and written communication skills including letters and emails 
• Ability to research and analyze data 
• Ability to work independently with minimal supervision 
• Ability to work effectively with insurance companies, providers, management and staff 
• Proficient with Microsoft Office Applications.  

Education, Experience, and Licensing  

• High school diploma or equivalent 
• Two years of credentialing experience, preferred  

Competencies 

· Integrity — Job requires being honest and ethical. 

· Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems. 

· Attention to Detail — Job requires being careful about detail and thorough in completing work tasks. 

· Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations. 

· Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high-stress situations. 

Lines of communication 

· This position will report directly to the Director of Billing. 

Working conditions 

· Full-Time – 40 hours a week. 

Candidates must meet the company’s hiring criteria to include a pre-employment background investigation and drug test. We are an Equal Opportunity Employer and a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. 

ICBD offers a competitive compensation and benefits package including a base salary with performance-based incentives; medical, dental, vision, short and long-term disability, life insurance, and 401(k). 

Team Members excluded from Federal Healthcare Programs.

Exact Billing Solutions operates facilities that receive federal funding and may not employ or contract with an individual or entity that has been excluded from health care programs (for example, Medicare or Medicaid). Accordingly, if a team member or agent has been excluded from or is under investigation and may be excluded, they must notify a member of management immediately. 

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