Credentialing Specialist

Overview

Join a collaborative, supportive team that plays an important role in helping our providers deliver care to patients. You’ll work with experienced credentialing professionals who value teamwork, open communication, continuous improvement, and professional growth. Our work is fast-paced and meaningful, with opportunities to solve problems, improve processes, partner across the organization, and make a measurable impact.

The Credentialing Specialist is responsible for all functions associated with credentialing of new clinician/locations and recredentialing/revalidation of existing clinicians/locations.  The Credentialing Specialist reports to Credentialing Manager and supports the department through maintaining of current information on file and within credentialing database as well as staying up to date on payer changes.

This position primarily works independently, but frequently coordinates with other team members, Credentialing Manager and Credentialing Director.

This is a remote position for United States based employees.

Responsibilities

• Monitor new location enrollments and manage existing locations up for revalidation enrollments with contracted payers
• Manage new hire clinicians onboarding credentialing documents and existing clinicians up for recredentialing with contracted payers.
• Respond to inquiries pertaining to recredentialing/revalidation/attestations for clinicians and locations
• Manage clinician and location terminations from participating insurance plans
• Maintain Credentialing Matrix up to date
• Utilize analytical skills to review and monitor aging reports
• Monitor rejection trends through observations and/or data analysis
• Assist in identifying changes in policies and procedures to improve efficiencies; suggest ways to improve workflows

Qualifications

Minimum Education Required:

• High School Diploma or equivalent

Minimum Experience

• At least 1 year of experience working with insurance plans preferred but not required.
• Strong computer skills including Microsoft Office preferred but not required.

Knowledge Skills and Abilities

• Strong communication and organizational skills.
• Strong attention to detail.
• Ability to maintain positive and professional relations with clients, coworkers, and managers.

Virtual Employee?

Salary Range

Location/Org Data : Dept Number