We have several contract openings for Credentialing Specialists. If you have worked in provider offices, have good customer service skills and understand medical terminology then send us your resume for immediate consideration.
This position involves extensive oral and written communication with providers in a professional and timely manner. The incumbent is responsible for coordinating efforts with several departments to ensure guideline compliance and provider education. This position assists with research on Participating agreements; and performs enrollment application quality reviews. This position is also responsible for ensuring accurate and timely IRS tax reporting compliance, staying abreast and implementing new IRS regulations and technologies such as TIN Matching, as related to the establishment of all provider records, 1099, B-Notice and backup withhold processes.
Credentialing specialists often work independently. This requires the specialist to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals, office personnel, and the public is standard.
- Maintain compliance with all regulatory and accrediting institutions
- Monitor credentials and licenses
- Advise staff on renewal procedures
- Participate in the development of internal credentialing processes
- Keep records in licenses, credentials and insurance contracts
- Release information to agencies and members of the public as required by law
Summary of Qualifications
- Experience in claims, customer service or other related member or provider support role
- Excellent written and oral communication skills
- PC Skills
- Strong attention to detail
- Previous written and telephone correspondence experience preferred
Applicants are required to take and pass the Typing and Basic Computer Literacy assessment.