Credentialing Specialist

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

📋 Description

• The Credentialing Specialist will be tasked with the prompt submission and follow-up for both institutional and individual provider credentialing, contracting, and re-credentialing with health insurance payors across various states and service lines.

• Assists in the verification and monitoring of healthcare providers' credentials and completion of facility applications as necessary.

• Maintains confidential records of provider files to comply with company and regulatory standards.

• Prepares and submits credentialing applications along with supporting documentation for enrolling groups and providers in Commercial, Medicare, and Medicaid networks.

• Follows up on the status of provider applications with payers, tracking the progress of pending and completed submissions.

• Keeps an accurate and updated database of information, including provider credentials and payer statuses.

• Collaborates closely with internal teams to communicate approvals and navigate denials as needed.

• Stays informed about current payer requirements across multiple states and service lines.

• Upholds a strict level of confidentiality and adheres to HIPAA compliance.

• Possesses familiarity with state licensing requirements and provider onboarding processes.

• Has experience with various payer portals and CAQH.

• Contacts providers and payers via phone or email to obtain updates or request any missing information.

• Ensures that group and provider information remains current and accurate with health insurance payers.

• Assists with facility credentialing applications as necessary.

⛳️ Requirements

• A minimum of two years of health insurance credentialing experience is preferred.

• Previous experience in data management/data integrity is preferred.

• An Associate's degree is preferred.

• Proficiency in Microsoft Office, including Excel, Word, and Outlook.

• Excellent organizational and communication skills.

• Quick thinking, positive, and professional demeanor, with proven problem-solving abilities, attention to detail, and critical thinking skills.

• Ability to work independently, prioritize tasks, and meet deadlines.

• Adaptable to changes in the work environment, capable of managing competing demands, and handling frequent changes, delays, or unexpected events.

• Ability to work effectively in a team environment.

🏝️ Benefits

• PTO and Paid Holidays for Full-Time Employees.

• 401k Retirement Plan with Company Match.

• Insurance programs including medical, dental, vision, company match for your HSA, FSA, company-paid EAP, life and disability insurance, and more.