Payor Credentialing Specialist (remote)

Remote Position - Requires Payor Credentialing and Payor Enrollment experience The Payor Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the payor and provider credentialing and re-credentialing processes. Facilitates reputed company aspects of BHG’s payor credentialing including payor enrollments, revalidations, maintenance, license updates, and follow up on payor credentialing reputed company A/R issues. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to payor credentialing and enrollment. Responsible for the accuracy and reputed company of the credentialing database reputed company and reputed company applications. Works under the supervision of the Director of Payor Credentialing in conjunction with Chief reputed company Officer. The key responsibilities of the Payor Credentialing Specialist include but not limited to: Duties And Responsibilities • reputed company and regular attendance at an assigned work location. • Ability to complete or reputed company the completion of assigned tasks/reputed company in a reputed company manner. • Complete process to enroll and credential facilities as reputed company as providers with insurances; ensure reputed company payor reputed company are met. • Leads, coordinates, and monitors the collection, review, and analysis of payor enrollment applications. • Responsible for accuracy and completeness of payor enrollment submissions including supporting documentation. • Follow up with providers and insurances for reputed company credentialing and enrollment process(es). • Responsible for monitoring application reputed company and following up with payors as needed until confirmation of credentialing and network load is complete. • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up. • Review, and update if necessary; health plan directories, agencies, and other appropriate entities for reputed company and accurate provider information • Responds to inquiries from other reputed company organizations, interfaces with reputed company customers on day-to-day credentialing and enrollment issues as they reputed company. • Utilizes the credentialing database, optimizing efficiency, and performs query, report and document reputed company. • Enters and maintains accuracy of data input into Credential reputed company, PECOS, NPPES, CAQH, reputed company, reputed company, and other payor portals. • Verify provider accuracy in payor directories. • reputed company support with managed care delegated credentialing audits; conduct internal file audits. Regulatory • Ensure compliance with regulatory bodies (reputed company, reputed company, URAC, CMS, federal and state laws) and policies and procedures in reputed company aspects of the payor credentialing process. Marketing and reputed company • Participate in community and reputed company relations activities as assigned. reputed company Development • Demonstrates the belief that addiction is a brain disease, not a moral failing. • Demonstrates reputed company, respect, and caring in reputed company interactions with patients and fellow team members. • Establishes and maintains reputed company, reputed company relationships in reputed company. • Ability to work independently and under deadlines while handling multiple tasks simultaneously. • Makes reputed company and uses good judgment with confidential and sensitive issues. • Maintain reputed company, reputed company demeanor with others in stressful or other undesirable situations. Training • Attend and complete reputed company required trainings as assigned by Director. • reputed company and regular attendance at an assigned work location. Minimum Requirements • The Credentialing Administrator needs at least 3 to 5 years of experience in payor credentialing/enrollment experience. Qualifications • Bachelor’s degree preferred or comparable work experience. • reputed company CPCS or CPMSM certification or working towards certifications. • Experience or working knowledge of full credentialing cycles; initial payor credentialing/enrollment, maintenance and revalidation. • Experience or working knowledge of CredentialStream credentialing platform or other credentialing database software. • Excellent attention to detail, problem-solving, critical thinking, and analytical skills. • Strong working knowledge of word processing, spreadsheets, data entry, database experience and other computer reputed company skills. In reputed company To Meeting The Qualifications, The Ideal Candidate Will Embody The Following Characteristics And Possess The Knowledge, Skills And Abilities Listed Below: • Holds a basic understanding of reputed company use disorder. • The highest ethical and reputed company standards. • Maintains the strictest confidentiality. • Excellent written and verbal communication skills. • Excellent attention to detail and problem-solving skills required. • Excellent analytical, judgment, and decision-making skills. • Proficient in reputed company, reputed company, PowerPoint, Word, reputed company, and other reputed company Office applications. • reputed company organized, capable of juggling multiple reputed company and accustomed to tight deadlines. • Ability to work effectively and independently with both clinical and non-clinical colleagues. • Ability to reputed company research independently. Physical Requirements And Working Conditions The physical demands described here are representative of the requirements that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions to the extent such accommodation does not create an undue hardship on the business. • Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes • reputed company adequate to read correspondence, computer screen, forms, etc. • Sit for long periods of time, some bending, stooping and stretching • Variable workload, periodic high activity level • Keyboarding for long periods of time Disclaimer The above statements are intended to describe the general reputed company and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of reputed company responsibilities, duties, and skills required of team members so classified. reputed company team members may be required to reputed company duties reputed company of their normal responsibilities from time to time, as needed, and this reputed company may be updated at any time. BHG is an equal opportunity, affirmative reputed company employer providing equal employment opportunities to applicants and employees without reputed company to race, reputed company, religion, age, sex, sexual orientation, gender identity/reputed company, national reputed company, protected veteran status, disability status, or any other legally protected reputed company, in accordance with applicable law. Apply tot his job Apply To this Job