Credentialing Specialist

2 months ago


Baltimore, United States Three Point Solutions Full time
Job DescriptionJob Description

Job Title: Credentialing Specialist (Hybrid)

Client: Health Care Insurance

Duration: 6 Months

Location: Baltimore, MD 21224

Top 5 Required Skills:

  • Proficient in Excel
  • Credentialing Knowledge
  • Customer Service skills
  • Written Communication skills

Purpose:

  • Credential practitioners for network participation with Client. Maintain provider data to ensure compliance with regulatory, accreditation, legal, and company requirements.

Essential Functions:

  • 40% Analyze credentialing applications to verify credentials for Client network participation. Determine appropriate networks and obtain executed contracts.
  • 30% Respond to inquiries regarding provider eligibility, credentialing, status, and updates. Ensure timely resolution and proactive measures.
  • 15% Maintain provider files, update information during credentialing, recredentialing, and other maintenance activities.
  • 10% Identify, analyze, and resolve provider file issues. Verify data and ensure successful system integration.
  • 5% Prepare written responses and communicate effectively to obtain missing information.

Qualifications:

  • Education Level: High School Diploma
  • Experience:
    • 3 years in physician credentialing or health insurance/managed care operations
    • Customer service, claims, billing and enrollment, or call center experience

Preferred Qualifications:

  • Bachelor's Degree in Business, Healthcare Administration, or related field

Knowledge, Skills, and Abilities (KSAs):

  • Proficient in Excel, including Pivot tables
  • Excellent verbal and written communication and interpersonal skills
  • Ability to develop and maintain effective relationships
  • Knowledge of medical terminology
  • Proficiency in using reference materials and following SOPs
  • Understanding of jurisdictional requirements and legal ramifications

Licenses/Certifications:

  • Certified Provider Credentialing Specialist (CPCS) Preferred

#ZR



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