Managed Service Organization has immediate need for Credentialing Specialist. This is a work from home position. Requires a dedicated workspace, without interruptions during work hours. Employees must provide high speed internet connection at their own cost. Company will provide necessary equipment to complete the job duties.
Advertisements
Work hours: Monday through Friday, from 8:00 AM to 5:00 PM EST.
Duties and Responsibilities:
- Collects and maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers
- Completes and submits initial credentialing and re-credentialing applications to health plans and hospitals/facilities for all providers
- Follows up with health plans, both commercial and government, and hospitals/facilities to ensure receipt and processing of credentialing applications
- Follows application processing, as needed, until completion: provider is contracted with health plans and granted privileges at hospitals/facilities
- Sends notifications to health plans and hospitals/facilities regarding provider changes, including changes to names, service locations, and addresses
- Maintains updated CAQH profile for all providers
- Processes NPI Updates
- Works with Billing and AR Department to assist in resolving claims payment resulting from enrollment or credentialing issues
- Maintains a credentialing database/tracking system
- Maintains knowledge of current health plan and agency requirements for credentialing and contracting
- Other responsibilities and duties, as assigned
Education and Work Experience:
- High school diploma or equivalent required
- Associate degree preferred
- CPCS certification preferred
- Minimum 3 years work experience in credentialing required
Job Related Skills and Competencies:
- Proficient in Windows and MS Word, Excel, Outlook, and Internet
- Above average writing and verbal communication skills
- Detail oriented with solid organization and time management skills
- Endurance and motivation to perform repeated tasks and respond quickly to requests for assistance from providers and company management
Advertisements
