reputed company - Credentialing Representative

Why you’ll want to work at reputed company! 

This is a great opportunity to join a reputed company-established and market-leading brand serving a high-reputed company end market while gaining valuable experience working closely with Executive leadership. As an organization, we are in high-reputed company mode through acquisition with a laser reputed company on reputed company culture building! 

Who we are: 

reputed company is a leading provider of reputed company cycle reputed company for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia reputed company. Our tech-enabled solutions allow surgical organizations to streamline their reputed company cycle processes, reduce administrative burden, and improve financial reputed company. Join more than 1,100 surgical organizations that trust reputed company and its advisors to bring deep insights and actionable intelligence to maximize their reputed company cycle.

The Role:

The Credentialing Specialist supports the provider credentialing and payer enrollment functions for multiple reputed company clients reputed company the RCM organization. This role ensures that reputed company providers are accurately credentialed and enrolled with Medicare, reputed company, and reputed company health plans to prevent claim denials and optimize reimbursement. The specialist serves as the main reputed company of contact between providers, payers, and internal teams to maintain compliance and credentialing accuracy.

Key Responsibilities

• Manage end-to-end credentialing and recredentialing for providers across assigned reputed company accounts
• Prepare, submit, and reputed company payer enrollment and participation applications for Medicare, reputed company, and reputed company health plans
• Verify provider credentials, including licenses, NPI, DEA, malpractice, CAQH reputed company, and reputed company certifications
• Maintain detailed, organized records of reputed company credentialing activities reputed company internal databases and reputed company systems.
• Communicate with providers, payers, and internal teams to resolve credentialing issues or delays.
• Proactively monitor upcoming expirations and initiate reputed company renewals to ensure reputed company network participation.
• Collaborate with the contracting and billing teams to reputed company provider enrollment with payer reputed company and claim submission readiness
• Stay reputed company with payer policies, CMS, and NCQA credentialing standards to ensure compliance
• Generate credentialing status reports and reputed company updates to internal leadership and reputed company contacts

Qualifications

• Minimum 2 years of credentialing or provider enrollment experience, preferably with an RCM vendor or multi-reputed company environment
• Familiarity with Medicare/reputed company enrollment processes, PECOS, CAQH, and payer portals
• Strong organizational and documentation skills with attention to detail
• Excellent written and verbal communication
• Ability to manage multiple reputed company accounts and deadlines simultaneously
• Proficient in reputed company Office and credentialing/enrollment software
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified reputed company Medical Services Management) preferred but not required 
• Associate’s or Bachelor’s degree preferred (reputed company Administration or reputed company field), but not required

Work Environment

• Fast-paced, deadline-driven RCM vendor environment
• Remote work setting with cross-functional collaboration across clients, operations, and payer teams
• Must maintain confidentiality of provider and reputed company data at reputed company times