Healthcare Provider Credentialing Specialist - Remote - Part-Time

Overview

We are seeking a detail-oriented individual to join our team as a Healthcare Provider Credentialing Specialist. Your expertise will be essential in providing exceptional service to our clients. Come join us and make a meaningful impact in the healthcare industry!

The Healthcare Provider Credentialing Specialist is responsible for ensuring that Healthcare Providers meet the necessary qualifications and credentials required by regulatory bodies, insurance companies, state and federal payors and healthcare organizations. You will play a crucial role in verifying the professional background and qualifications of Healthcare Providers to ensure continued compliance with regulatory and payor requirements and maintain the highest standards of patient care.

***This is a Part-Time Position***

Responsibilities

• Prepare and submit credential applications to relevant organizations, insurance companies, and government agencies. Ensure accuracy and completeness of all required documentation.
• Manage the credentialing process for healthcare providers, including physical therapists, physical therapist assistants (“PTAs”), occupational therapists, certified occupational therapy assistants (“COTAs”) Speech Language Pathologists (collectively, “Therapists”) and other allied health professionals. The credentialing process includes collecting and verifying information including education, training, licensure, certifications, work history, and references.
• Ensure timely enrollment and maintenance of Therapists in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). Complete, track and monitor Medicare PECOS applications and updates to support compliance with federal regulations and billing requirements. Maintain and update Medicare Identity & Access (I&A) accounts and National Plan and Provider Enumeration System (NPPES) records, as necessary.
• Conduct thorough verification of credentials by contacting educational institutions, licensing boards, professional organizations, and previous employers. Maintain detailed and up-to-date records of all verified credentials.
• Stay updated with the latest regulations, standards, and guidelines related to credentialing and ensure compliance with all applicable laws and regulations. Adhere to the policies and procedures of Symbria.
• Collaborate with healthcare providers, insurance companies, and internal stakeholders to resolve any credentialing-related issues or discrepancies. Communicate effectively and professionally with all parties involved.
• Maintain accurate and organized credentialing databases and systems. Ensure confidentiality and security of all sensitive information.
• Monitor and manage the re-credentialing process to ensure timely renewals of credentials for all Healthcare Providers. Send reminders to Healthcare Providers regarding upcoming expirations and assist in the renewal process.
• Participate in quality assurance activities to ensure the accuracy and integrity of the credentialing process. Identify areas for improvement and implement necessary changes to enhance efficiency.
• Create new and maintain employee Council for Affordable Quality Healthcare (CAQH) profiles.
• Update Proview (CAQH’s credentialing website) with new practice locations.
• Communicate with team members as needed to assure that healthcare providers are and remain credentialed.
• Maintain and update the CAQH profile tracking report.
• Respond to insurance companies and payors documentation requests as needed.
• Work with ProView to merge profiles/fix profiles.
• Attending weekly update meetings.
• Any and all duties as assigned.

Qualifications

To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required:

• High school diploma, general education degree (GED).
• Previous experience in medical credentialing or related field.
• Knowledge of credentialing processes, regulations, and standards.
• Familiarity with medical terminology and the healthcare industry.
• Attention to detail and organizational skills.
• Excellent communication and interpersonal skills.
• Proficient in using credentialing software and databases.
• Ability to work independently and handle multiple tasks simultaneously.
• Adherence to ethical standards and confidentiality guidelines.
• Proficient use of a computer and Microsoft Office: Word, Excel, and Outlook.

QUALIFICATIONS preferred

• Associate or Bachelor's degree.

Why work for us?

At Symbria our employees act like owners – because we are owners!  As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents.  Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options.

Symbria’s Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together:

• Integrity – Honest, Fairness and ethics
• Compassion – Commitment to serving seniors
• Stewardship – Maximizing mission and margin
• Innovation – Striving to enhance our value to your organization
• Teamwork – Working together unselfishly toward goals

As an employee-owner, Symbria’s success becomes your success.  In addition, we provide:

• Competitive pay, aligned with market guidelines
• Full Benefits Package, including very generous paid time off plans
• Professional liability coverage
• 100% employer-funded ESOP retirement plan
• 401(k) and Roth(k) plans
• Continuing education
• Credit union membership

Symbria does not discriminate for any reason. We welcome talent who believes in our mission, drives the organization forward and cares about the value they bring to an organization. 

#LI-REMOTE