Credentialing Specialist

Credentialing Specialist

Description:

Responsibilities:

• Monitors tasks within credentialing platform to mitigate any delays and ensure completion from internal stakeholders.
• Actively reviews and resolves Enrollment dashboard issues within EMR system.
• Alerts management to unfavorable patterns/trends.
• Verify participation of all line of business with a payer.
• Contact payer(s) on claims when an enrollment issue exists.
• Acts as a point of contact for assigned department(s) for incoming questions regarding third-party billing requirements because of payer enrollment.
• Analyzes trends in under/overpayments and payment denials and works collaboratively.
• Keep provider enrollment tables up to date with effective participation/term dates, taxonomy codes, NPI within EHT platform.
• Completes all internal On/Offboarding tasks for all clinicians.
• Updates fee schedule in Practice Management system as needed.
• Maintains allowable schedules in the Practice Management system, as needed.
• Other duties as assigned.

Requirements:

Education and Certifications:

• High school diploma or GED required.
• High level of proficiency in Microsoft Excel.
• Ability to work autonomously and as a member of a team, team player with a positive attitude.

Experience:

• 5+ years in a healthcare related industry
• All aspects of Payer Credentialing
• Front office operations
• Payer follow-up and collections

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.