Credentialing and Licensing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise the credentialing, recredentialing, and health plan or hospital privileging processes for physicians and qualified healthcare professionals.

• Ensure that physicians receive privileges as mandated by specific health plans.

• Oversee and track facility credentialing for ambulatory surgical centers, pharmacies, and laboratories.

• Execute credentialing and licensing responsibilities with expertise, consistency, and quality.

• Compile and sustain current and accurate electronic provider data.

• Complete and uphold ARMS credentialing and recredentialing for organizations utilizing BetterHealth’s services.

• Apply for ARMS malpractice coverage for new APRNs, PAs, and physicians, including offsite emergency coverage for physicians.

• Conduct annual reviews of provider malpractice coverage.

• Maintain documentation in third-party systems like Modio and CredentialSmart for primary source verification.

• Create, update, and manage CAQH ProView accounts and acquire accounts for new providers.

• Obtain, update, and maintain NPPES/PECOS accounts for APRNs, PAs, and physicians.

• Keep electronic copies of licenses, board certifications, DEA registrations, required certificates, malpractice coverage, and other credentialing documents.

• Acquire electronic signatures from new providers.

• Complete, monitor, and follow up on credentialing and recredentialing applications with commercial, Medicaid, Medicare, and Medicaid managed care payers.

• Provide payers with demographic updates when providers are added or terminated.

• Maintain electronic folders of signed physician contracts and archived contracts.

• Safeguard the confidentiality of provider and corporate information for federal and state agencies.

• Assist with revenue cycle processes including appeals, billing, follow-up, insurance benefit verification, payment posting, self-pay collections, and customer service.

• Exhibit effective customer service and communication with internal teams and affiliate clients.

• Operate as a self-starter with minimal supervision.

• Perform additional duties as assigned.

• Travel between and throughout facilities as necessary.

⛳️ Requirements

• High school diploma or GED.

• At least three years of direct experience with credentialing providers in a medical practice.

• Knowledge and understanding of credentialing processes with health insurance plans.

• Experience using CAQH ProView.

• Familiarity with state Medicaid plans.

• Ability to manage highly confidential and sensitive matters and documents.

• Competence in identifying problems, collecting data, establishing facts, and drawing valid conclusions.

• Knowledge of business practices and protocols.

• Capacity to manage multiple priorities and projects.

• Ability to work with minimal guidance.

• Exceptional time management and organizational skills.

• Adaptability and flexibility in response to changing end-user business needs.

• Willingness to learn new software and systems.

• Understanding of racial inequity and its impact on healthcare systems and institutions.

🏝️ Benefits

• Less than 5% travel required.

• Reasonable accommodations for individuals with disabilities.