About This Role
The Credentialing Specialist is responsible for collecting and confirming provider information to process and file reports with accrediting and licensing agencies, as well as maintaining a database of provider information. This role works closely with insurance companies and government payers to supply provider and client information.
Responsibilities
- Manage the initial and re-appointment application process by working with providers to complete paperwork timely and assisting with obtaining outstanding documents and verifications to meet established deadlines
- Work closely with HR to ensure candidates have completed and submitted all required documents prior to On-Boarding
- Review all applications for completeness and accuracy, ensuring that all information meets federal, state, or commercial insurance guidelines when processing applications
- Ensure that provider medical licenses, board certifications, DEA and other pertinent information is renewed prior to expiration
- Assist with provider CAQH enrollment
- Assist with federal and commercial insurance program enrollment and maintenance
- Perform all other contracting and maintenance needs required by payors
- Utilize software to help maintain, track, and update all insurance payor contracts for multiple practices in multiple states
- Maintain and update credentialing insurance matrix and rosters
- Manage and maintain relationships with all payors to improve revenue
- Follow written and verbal instructions from the Director of Revenue Cycle Management
- Exhibit professionalism in communication with payers and co-workers
- Participate in special projects
- Support Variety Care
- Provide leadership and work with all staff to achieve the goals of the
- Embody the strength of personal character
- Perform other duties as assigned
Requirements
- High School diploma or GED
- 5 years of administrative experience
- Experience working in a fast-paced, highly accountable environment
- Experience prioritizing and engaging in constructive feedback and quality improvement
- Expert critical thinking, analytics, problem-solving and sound decision-making skills
- Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations
- Proficient skills with Microsoft Office and Adobe software
Nice to have:
- Associates degree or equivalent combination of experience and education
- Medical credentialing experience
Important Details
