Medical Credentialing Specialist
4 weeks ago
As a Medical Credentialing Specialist, you will be responsible for ensuring that healthcare providers meet all necessary qualifications and standards set by regulatory bodies and insurance companies to deliver medical services. Your role is crucial in maintaining the integrity and quality of healthcare services provided to patients.
**Key Responsibilities**:
Credentialing Process Management:
- Manage the entire credentialing process for healthcare providers, including physicians, nurses, therapists, and other allied health professionals.
- Gather and verify required documentation, such as medical licenses, certifications, education credentials, and professional references.
- Coordinate with healthcare providers and relevant institutions to obtain necessary documents and information.
- Maintain accurate and up-to-date credentialing files for each provider.
Credentialing Application Submission:
Provider Enrollment and Revalidation:
- Assist healthcare providers with the enrollment process with insurance networks and managed care organizations.
- Monitor provider enrollment status and initiate revalidation processes as required.
- Coordinate with billing and administrative teams to ensure timely reimbursement for services rendered.
Compliance and Quality Assurance:
- Stay updated on regulatory changes, accreditation standards, and industry best practices related to credentialing and provider enrollment.
- Ensure compliance with all applicable laws, regulations, and organizational policies.
- Participate in internal and external audits to assess and improve credentialing processes.
Communication and Collaboration:
- Serve as a liaison between healthcare providers, insurance companies, and other stakeholders involved in the credentialing process.
- Communicate credentialing requirements and updates to healthcare providers and administrative staff.
**Qualifications**:
- Previous experience in medical credentialing, provider enrollment, or healthcare administration strongly preferred.
- Knowledge of credentialing standards, regulations, and processes, such as those set by NCQA, Joint Commission, and CMS.
- Strong attention to detail and organizational skills.
- Excellent communication and interpersonal skills.
**Job Types**: Full-time, Contract
Pay: $18.00 - $25.00 per hour
Work Location: Hybrid remote in Schenectady, NY 12305
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