Credentialing Specialist

Job Description

Job Description

We are looking for a detail-oriented Credentialing Specialist to join our team in Manhattan Beach, California. The Credentialing Specialist will play a pivotal part in ensuring providers are properly credentialed with Medicare and commercial insurance plans. This position offers an excellent opportunity to expand your expertise and gain hands-on training in medical billing.

Responsibilities :

• Credentialing processes for 12-13 healthcare providers, ensuring compliance with Medicare and commercial insurance requirements.
• Prepare and submit detailed applications for provider credentialing and re-credentialing.
• Maintain accurate and up-to-date records of provider credentials and certifications.
• Collaborate with insurance carriers to resolve credentialing-related issues efficiently.
• Monitor and track credentialing timelines to ensure timely renewals and updates.
• Assist in identifying and implementing process improvements for credentialing workflows.
• Provide support and training in medical billing processes, as required.
• Act as a liaison between providers and insurance companies to address credentialing inquiries.
• Ensure adherence to regulatory standards and organizational policies.
• Generate reports and documentation related to credentialing activities for internal review.
• Proven experience in credentialing processes, including provider and physician credentialing.
• Familiarity with Medicare and commercial insurance credentialing requirements.
• Strong organizational skills and attention to detail for managing multiple providers.
• Ability to effectively communicate with insurance carriers and healthcare professionals.
• Proficiency in tracking and maintaining credentialing records.
• Willingness to learn and develop skills in medical billing.
• Knowledge of re-credentialing applications and procedures.
• Experience with credentialing software or systems is an advantage.