Credentialing Specialist I

Job Description:

Job Duties 

• Maintain organized and accurate files to ensure the credentialing is obtained from all physician and non-physician providers.

• Timely and appropriately apply for, process, submit, and maintain credentials and licensing with insurance companies and federally subsidized government plans, such as Medicare and Medicaid

• Ensure that all insurance companies have current and accurate information they need to process claims in a timely manner.

• Verify compliance of all documents prior to submission.

• Communicate effectively with clients on payer registration status and updates.

• Build and maintain relationships with payer representatives.

• Proactively identify and resolve any issues a client may face during the payer registration process.

• Demonstrate self-management behaviors and being a self-starter, following established policies and procedures and promote an efficient, cost-effective work environment.

• Keep RCM Account Managers, Supervisors and management, and providers informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, etc. to prevent delayed claims filing and cash flows.

• Sets up and maintains provider information in online credentialing databases and system

• Track license and certification expirations for all providers to ensure timely renewals

Job Requirements 

• 1-2 years of insurance credentialing experience including federal government plans

• Certified Provider Credentialing Specialist (CPCS) preferred

• Hands-on knowledge of the credentialing process

• Strong written and oral communications skills

• Working knowledge of Medical Terminology.

• May require some travel

• Experience working directly with providers

• Microsoft Office Suite

• Ability to work in a fast-paced environment

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.