Credentialing Specialist – Coordinator

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

📋 Description

• Assist healthcare providers during the privileging and credentialing process upon employment acceptance.

• Initiate hospital credentialing for physicians and work in partnership with UMass to uphold physician hospital appointments.

• Manage internal provider IDs, rosters, provider details, and access to NPI/PECOS.

• Aid providers in the application and renewal processes for professional, DEA, controlled substance, and other necessary practice licenses and documentation.

• Conduct primary source verifications mandated by CMS, HRSA, Joint Commission, and NCQA.

• Organize compliance training sessions, CME opportunities, and Life Support Training.

• Oversee the re-credentialing of providers for both the Health Center and UMass.

• Ensure accurate provider credentialing profiles are maintained within the Cactus Cred software.

• Monitor and report on credentialing expirables on a monthly basis.

• Complete MassHealth and PECOS revalidation requests.

• Fill out credentialing applications for commercial payers, Medicare, and Medicaid.

• Track and report on the progress of provider enrollment.

• Initiate and manage provider CAQH database files in accordance with CMS timelines.

• Complete re-credentialing applications for commercial payers.

• Collaborate with the Revenue Cycle Director and billing personnel to address credentialing-related denials and authorization challenges.

• Create and sustain provider profiles in CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases.

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma, GED, associate degree, or bachelor's degree is required.

• A minimum of 2 years of credentialing experience is preferred.

• At least 2 years of experience in a medical practice business office role is mandatory.

• Understanding of provider credentialing and enrollment and their influence on the practice's revenue cycle is essential.

• Proficient computer skills, including Excel, Word, and Internet navigation for state and federal sites and health-plan searches.

• Detail-oriented with robust organizational and time-management abilities.

• Capability to plan and prioritize tasks to meet deadlines effectively.

• Outstanding customer service skills.

• Clear, effective, and professional communication skills.

🏝️ Benefits

• Assist/support providers in obtaining compliance trainings, CME opportunities, and Life Support Training as required.