Job Description
Job Description
Salary :
The Credentialing Specialist will ensure that appropriate processes are in place to monitor and maintain systematic, timely credentialing and re-credentialing of network providers.
Performs a meticulous review of health provider’s qualifications, Submits the information with necessary applications to insurance companies and other payers.
Essential Duties and Responsibilities
- Initiate and complete the provider enrollment credentialing and recredentialing process for physicians.
- Assist providers in completion of various applications for managed care participation.
- Ensure provider practice addresses are current with health plans.
- Update and provide quarterly rosters to payers in accordance with their policies and procedures.
- Audit health plan directories for current and accurate provider information.
- Maintain timely and accurate data entry of provider data in CAQH.
- Monitor expiring licensure, board and professional certifications and other documents that expire for all providers and ensure timely renewals.
- Assist in trouble-shooting provider plan participation interruptions and other member related issues.
- Assist and maintain internal fee schedules for North and South Carolina.
- Adhere to policies and procedures including data security, confidentiality and timely delivery of completed work.
- Other duties as assigned.
Requirements
- 2-3 years of credentialing experience
- Ability to meet deadlines and prioritize.
- Knowledge of provider credentialing requirements
- Ability to manage multiple projects effectively.
- Ability to analyze, interpret and synthesize a wide range of information, including legal and contract language, policies, standards and guidelines.
- Represents the office / Organization in a positive manner.
- Possess analytical and problem-solving skills.
- Must maintain patient / client confidentiality.
Physical Requirements
Must be able to sit for long periods of time and work in a fast-paced office environment. Should be able to bend and lift up to 10 lbs.
Reports to : Director of Operations
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