Specialist II, Credentialing

Job Description :

The Specialist II, Credentialing will perform duties associated with credentialing, re-credentialing, and privileging network providers.

Collaborate and meet regularly with vendor partner to ensure timely preparation and follow-up on provider enrollment applications;

as well as ensure re-credentialing and attestations are maintained.

• Routinely perform quality assurance calibrations with vendor partner to insure accurate application preparation and follow-up.
• Serve as the liaison between our vendor partner and multiple clients by meeting regularly with clients' Credentialing personnel to provide updates on provider enrollment, follow-up on required documentation requests, and other issues related to the Credentialing process.
• Collaborate with other departments on resolution of payer denials related to Credentialing
• Compile, maintain, and audit current and accurate Credentialing documentation for all active providers while maintaining confidentiality of provider information.
• Complete the provider enrollment process for specific payers (i.e. Government and other specialized payers) including, but not limited to, application preparation and submission, enrollment follow-up, re-credentialing, attestations, and provider terminations.
• Perform other duties that support the overall objective of the position.

Education Required :

• High School Diploma.
• Or, any combination of education and experience which would provide the required qualifications for the position.

Experience Required :

• 5+ years experience in customer and / or client service in the areas of medical billing, credentialing, finance, and accounting
• 3+ years of experience in Healthcare Provider credentialing, enrollment or related process is highly preferred.

Knowledge, Skills & Abilities :

Knowledge of : Medical billing and collections, credentialing, current health plans and agency requirements for credentialing providers, customer service best practices, basic medical terminology, HIPAA, laws, regulations, policies, and procedures governing the functional area;

Microsoft Office, Adobe.

• Skill in : Customer service, communication, collaboration, organized with a strong attention to detail.
• Ability to : Effectively communicate with cross-functional team members, peers, and management; providing customer service to internal and external stakeholders.

Build strong internal and external relationships, maintain confidential information, work in a fast-paced environment, stay organized, prioritize workload, multi-task, and meet deadlines.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described.

It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

This document does not represent a contract of employment, and the company reserves the right to change this job description and / or assign tasks for the employee to perform, as the company may deem appropriate.

NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.