Credentialing Specialist

The Credentialing Specialist reports to the Credentialing Manager and is responsible for timely submission and follow-up of payer enrollment applications and credentialing applications for appointment and re-appointment to hospitals and Ambulatory Surgery Centers (ASCs). 

• Add, update and maintain accurate provider information in CAQH, CredentialStream and other tools commonly utilized for credentialing and payer enrollment.
• Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding.
• Complete, submit, document and pro-actively track and follow-up on required credentialing, enrollment and re-credentialing applications, paying close attention to details.
• Gather, compile and continuously monitor information necessary for enrollment and credentialing purposes.
• Update and inform department and other leadership of progress and issues using various means of communication.
• Research and respond to internal and external inquiries related to enrollment and credentialing issues.
• Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for both facility credentialing applications and payer enrollment submission.
• Work collaboratively in a team environment to achieve team and organizational goals by sharing information and resources.
• May assist other team members with the provider licensing and renewal process.
• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity.
• Miscellaneous job-related duties as assigned. 

Education: Bachelor's degree

Experience: 3-5 years of experience in a medical service profession, payer enrollment, insurance plan, revenue cycle, or a combination.

• Must be accountable, organized and work independently to self-manage assignments.
• Knowledge and understanding of the credentialing process; ability to apply principles, procedures, requirements, regulations and policies.
• Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders.
• Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools.
• Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift.
• Express thoughts and information clearly, concisely and effectively both verbally and in writing.
• Critical thinker, anticipating next steps.
• CPCS certified a plus.
• Experience with CredentialStream preferred.
• Computer Proficiency, Microsoft Office to include Word, Excel, Power Point.

PRISM Vision Group is an Equal Opportunity / Affirmative Action employer.  Candidates are selected solely on the basis of legally permissible job-related criteria without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.