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.
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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
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