Credentialing Specialist

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

📋 Description

• Accurately and promptly complete credentialing and/or re-credentialing applications for physicians, ancillary providers, and facilities or groups with third-party payers and government programs such as Medicare and Medicaid, as requested by clients.

• Conduct Primary Source Verification (PSV) services, which include the verification of licenses, malpractice, and work history; perform PSV file audits as required.

• Create, update, and manage Council for Affordable Quality Healthcare (“CAQH”) profiles for providers.

• Maintain a Credentialing database following BerryDunn’s policies and procedures for all participating and non-participating providers, including payer identification numbers and effective dates.

• Collaborate with client liaisons, including billing departments, to refresh the enrollment status of the providers.

• Reach out to payers to follow up on submitted applications in accordance with BerryDunn’s policies.

• Respond promptly and professionally to various inquiries and information requests from participating physicians, staff, hospitals, and managed care organizations.

• Communicate with providers or their representatives to gather necessary credentialing information, ensuring timely completion and submission of required documentation.

• Provide regular updates to clients on the process and communicate any delays effectively.

• Keep Credentialing leadership informed about project status and assist in managing expectations regarding deliverables and deadlines.

• Ensure accurate and timely recording of hours (both billable and non-billable) in time and attendance software for appropriate billing of rendered services.

⛳️ Requirements

• A high school diploma is required; a bachelor’s degree is preferred.

• A minimum of 2-3 years of relevant healthcare experience is necessary, including specialized skills in Credentialing and/or Medical Billing.

• Certification as a Provider Credentialing Specialist (CPCS) or as a Certified Professional in Medical Staff Service Management (CPMSM) is advantageous.

• Ability to work autonomously as well as collaboratively within a team setting.

• Excellent organizational and time management abilities to handle priorities and deadlines effectively.

• Strong verbal, interpersonal, and written communication skills.

• High attention to detail and commitment to quality.

• Proficiency in Microsoft Office suite (Word, Outlook, Teams) and Adobe; Excel skills are preferred.

🏝️ Benefits

• Access to benefits that promote physical, mental, career, social, and financial well-being.