Full-Time Credentialing Specialist

Job Description

The Full-Time Credentialing Specialist is responsible for the timely execution of all group applications and provider applications/link letters. Serving as the point of contact for the organization’s credentialing application process, the Credentialing Specialist will communicate with providers and all teams to ensure accurate and up-to-date information regarding provider’s enrollment status.

Responsibilities

• Prepare new and existing provider enrollment applications and/or written link letters
• Create and submit new group enrollment applications when contracts are executed
• Follow up timely with payers on submitted applications/letters for approval notices
• Ensure timely revalidation of all providers and groups
• Communicate with providers and other team members to resolve payer issues and confirm participating status
• Manage all documentation in an organized manner – upload documentation to a shared drive and update Modio
• Track all provider licensure and communicate with provider prior to expiration
• Complete, update and maintain CAQH profiles for providers
• Identify and communicate any potential enrollment issues that could result in loss of revenue
• Establish relationships and maintain communication with provider representatives
• Set up provider portals and maintain access for team members as needed
• Participate in team meetings and communications
• Perform specific assignments as directed by the Revenue Cycle Director

Qualifications

• Maintain regulatory requirements, including all federal, state, local regulations and accrediting organization standards
• Knowledge of government and commercial payer’s enrollment processes and requirements
• Minimum 3 years’ experience in provider enrollment
• Preferred experience with Modio Health
• Detail-oriented, organized, and able to multitask
• Strong interpersonal and organizational skills
• Excellent customer service skills
• Able to work in a fast-paced, acquisitional environment
• Represent the organization in a positive and professional manner
• Demonstrated knowledge and experience working with provider enrollment
• Comply with all organizational policies regarding ethical business practices
• Proficient in all Microsoft Office applications