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6 days ago
As a Credentials Specialist, you will play a critical role in ensuring that all healthcare providers are properly credentialed and enrolled with payers.
Key Responsibilities:- Verify Provider Credentials: Verify provider credentials, including education, training, licensure, and certification, to ensure compliance with regulatory requirements.
- Enroll Providers with Payers: Enroll providers with payers, including Medicare, Medicaid, and commercial insurance companies, in accordance with company policies.
- Prepare and Submit Applications: Prepare and submit credentialing and enrollment applications to payers in a timely manner.
- Resolve Issues and Discrepancies: Follow up with payers to resolve any issues or discrepancies related to credentialing and enrollment.
- Maintain Credentialing Records: Maintain accurate and up-to-date records of provider credentials and enrollment status.
- Ensure Compliance: Ensure compliance with regulatory requirements, including HIPAA, OIG, and state-specific laws.
- Communicate Effectively: Communicate with providers, payers, and internal stakeholders to resolve credentialing and enrollment issues.
- Enter Data Accurately: Accurately enter data into credentialing and billing systems.
- Education: High school diploma or equivalent required; associate's or bachelor's degree preferred.
- Experience: 2+ years of experience in credentialing, medical billing, or a related field.
- Certifications: Certified Provider Credentialing Specialist (CPCS) or Certified Credentialing Specialist (CCS) certification preferred.
- Skills: Strong analytical, organizational, and communication skills. Ability to work in a fast-paced environment and meet deadlines.
- Software: Proficient in Microsoft Office and credentialing software systems.
We are looking for a motivated and detail-oriented individual to fill this role.
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