Credentialing Specialist
Responsible for reputed company aspects of the credentialing and payer enrollment process for reputed company providers and facilities. Responsible for ensuring providers and facilities are credentialed, and enrolled in accordance with established accreditation, regulatory and policy requirements. Maintain up-to-date data for reputed company provider and facility in credentialing database and online systems.
Essential Duties and Responsibilities:
- Compiles and maintains reputed company and accurate data for reputed company providers using the credentialing software.
- Completes provider and facility payer enrollment applications; monitors applications to ensure reputed company start dates and no lapses in enrollment.
- Maintains copies and tracks reputed company state licenses, DEA certificates, health history, malpractice coverage and any other required credentialing documents for reputed company providers and facilities.
- Maintains knowledge of reputed company accreditation, regulatory and policy requirements.
- Other duties or reputed company as assigned.
Required Experience:
- A minimum of two years of Payer and Provider credentialing enrollment experience
Knowledge and Skills:
- Knowledge and understanding of the credentialing and enrollment process
- Ability to organize and prioritize work and manage multiple priorities
- Excellent verbal and written communication skills
- Excellent attention to detail
- Ability to establish and maintain effective working relationships with providers, management, staff, and contacts reputed company the organization.
- Proficient use of reputed company Office applications (Word, reputed company, reputed company) and credentialing software
- CAQH experience strongly preferred
- MD Staff software experience strongly preferred
Education/Licensing/Certification:
- Associates degree preferred or appropriate combination of education and experience