Credentialing Specialist

Mindoula Health
Full time
Healthcare
United States
Hiring from: Anywhere

Title: Credentialing Specialist (Remote)



  • Location: Remote-US

  • Job Type: Full-Time


Job Desc:


Summary:


Managed Service Organization has immediate need for Credentialing Specialist. This is a work from home position. Requires a dedicated workspace, without interruptions during work hours. Employees must provide high speed internet connection at their own cost. Company will provide necessary equipment to complete the job duties.


Work hours:



  • Monday through Friday, from 8:00 AM to 5:00 PM EST.


Duties and Responsibilities:



  • Collects and maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers

  • Completes and submits initial credentialing and re-credentialing applications to health plans and hospitals/facilities for all providers

  • Follows up with health plans, both commercial and government, and hospitals/facilities to ensure receipt and processing of credentialing applications

  • Follows application processing, as needed, until completion: provider is contracted with health plans and granted privileges at hospitals/facilities

  • Sends notifications to health plans and hospitals/facilities regarding provider changes, including changes to names, service locations, and addresses

  • Maintains updated CAQH profile for all providers

  • Processes NPI Updates

  • Works with Billing and AR Department to assist in resolving claims payment resulting from enrollment or credentialing issues

  • Maintains a credentialing database/tracking system

  • Maintains knowledge of current health plan and agency requirements for credentialing and contracting

  • Other responsibilities and duties, as assigned


Education and Work Experience:



  • High school diploma or equivalent required

  • Associate degree preferred

  • CPCS certification preferred

  • Minimum 3 years work experience in credentialing requiredR


Job Related Skills and Competencies:



  • Proficient in Windows and MS Word, Excel, Outlook, and Internet

  • Above average writing and verbal communication skills

  • Detail oriented with solid organization and time management skills

  • Endurance and motivation to perform repeated tasks and respond quickly to requests for assistance from providers and company management


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