Credentialing Specialist

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

📋 Description

• Maintain up-to-date provider files for both governmental and commercial payer credentialing applications.

• Credential new providers and re-credential existing providers at clinics where they have staff privileges.

• Facilitate the completion of payer practitioner linking applications.

• Manage and uphold contracts, licenses, and credentials for current providers.

• Regularly communicate with payers regarding fee schedules, updates, and necessary documentation.

• Develop, implement, and oversee processes and procedures for delivering quality, efficient, and cost-effective contracting and credentialing services.

• Ensure compliance of the credentialing program with health plans, State and Federal regulations, Medicare, Joint Commission, IMQ, AAAHC, and other accrediting bodies.

• Monitor enrollment status with organizations, agencies, affiliates, and third-party payers.

• Maintain accurate provider profiles on CAQH, PECOS, and CMS databases.

• Keep databases for active provider files, including Verity and Availity.

⛳️ Requirements

• Bachelor’s degree or equivalent professional experience.

• 3-5 years of experience and proven success in provider and facility contracting and credentialing with both commercial and government payers.

• Preferred: Certified Provider Credentialing Specialist (CPCS) certification.

• Demonstrated experience working with multi-site and/or multi-state providers.

• Desired: Experience with Infusion, G/I, Rheum, Neuro, and/or large distributed medical practices.

• Exceptional written and verbal communication skills, with a proven ability to effectively engage with various external and internal stakeholders.

• Strong analytical and problem-solving abilities.

• Capability to identify and resolve ambiguous or conflicting objectives.

• Knowledge of provider credentialing and its direct influence on the practices' revenue cycle.

• Proficiency in standard office software applications (Microsoft Office, Outlook, Teams, etc.).

🏝️ Benefits

• 401(k), health benefits, and additional company-provided perks.

• Medical, Dental, and Vision Coverage.

• Prescription Drug Coverage and Telemedicine Services.

• Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), and Flexible Spending Options.

• 401(k) Retirement Plan with Company Match.

• Life, AD&D, and Disability Insurance.

• Accident, Critical Illness, and Hospital Indemnity Coverage.

• Support for Fertility and Family Planning.

• Tuition Reimbursement and Certification Assistance.

• Resources for Continuing Education and Professional Development.

• Employee Assistance Program and Wellness Support.

• Paid Time Off.

• Volunteer Time Off and Charitable Giving Match.

• Employee Referral Bonus Program.