Job Opportunities

Credentialing Specialist

Roles & Resposibilities

1. Process and manage Physician, Non Physician and Laboratory credentialing, Re Credentialing and enrollment applications with federal, state and comercial insurance payers.
2. Prepare, review and submit credentialing applications ensuring accuracy, completeness and compliance with payer requirements.
3. Monitor and followup on pending credentialing, enrollment, contracting and re credentialing requests to ensure timely completion and approval.
4. Maintain and update provider and laboratory records including CLIA, licenses, DEA, CAQH profiles, certifications, malpractice insurance and other required documents.
5. Track credentialing deadlines, license, CLIA renewals, re credentialing cycles and contract expiration dates to ensure continuous complkiance.
6. Communicate with insurance payers, providers, clients and internal stakeholders to resolve credentialing issues and obtain required documentation.
7. Ensure compliance with applicable fdederal regulations, state regulations, payer guidelines and organizational polices
8. Maintain accurate credentialing data and documentation within credentialing systems, databases and tracking tools.
9. Generate and maintain credentialing status reports, productivity reports and aging reports for management review.
10. Identify and escalate credentialing delays, discrepancies or compliance concerns to leadership in a timely manner
11. Participate in client meetings and provide credentialing status updates as required.
12. Collaborate with team members ti achieve departmental productivity, quality and turnaround time goals.
13. Support process improvement initiatives to enhance credentialing efficiency and accuracy.
14. Perform additional credentialing and administrative duties as assigned.

Requirements
1. Must have 2+ years of experience with medical credentialing
2. Must have strong knowledge of provider enrollment and credentialing processes.
3. Experience with CAQH, PECOS, NPPES and commmercial payer portals.
4. Must have Strong communication, Time managment, Analytial, Logical thinking, Interest in acquring new knowldge, Proactive approach.
5. Must have Bachelor's degree.