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Credentialing Specialist

4 months ago

Dover, United States Zufall Full time

Welcome to Zufall Health

Position Summary

Under the direct supervision of the Billing Claims Manager, the Credentialing Specialist will conduct all aspects of third-party credentialing for providers and facilities in accordance with FQHC and third-party insurance standards.

Essential Functions, Duties, and Responsibilities

  • Prepare and maintain Zufall credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements.
  • Process and file applications with third party payors according to each payor's individual requirements and addresses/corrects discrepancies as requested by payors.
  • Conduct all follow up steps until payor approval/completion is obtained.
  • File provider practice change notifications and perform follow up duties until confirmed complete by payors.
  • Update NPI records according to provider specifications.
  • Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
  • Track provider licensure and Board expirations and ensures timely processing CAQH, TMHP and payor updates.
  • Complete requests for re-credentialing for both providers and all facilities.
  • Accept and process all requests from payers for credentialing information/updates/new contracts and products.
  • Answer questions, process requests from staff/providers related to credentialing information.
  • Ensure all records meet standards set by carriers as well as FQHC guidelines.
  • Enrolls facilities in Medicare/Medicaid programs.
  • Address enrollment disconnects in regard to all facility and providers.
  • Maintains quarterly payor specific rosters in accordance with CMS standards.
  • Assist in quarterly CAQH mass attestation.
  • Serves as liaison between Zufall and outside organizations and external customers.
  • Participates in the Performance Improvement Program.
Knowledge, Skills, and Abilities
  • Knowledge of Microsoft Office, keyboarding, and use of electronic medical records
  • Must have strong, clear communication skills
  • Detailed oriented and organizational skills required
  • Have good working knowledge of guidelines and requirements of agencies and carriers
Education, Training, and Experience
  • At least five years' experience in capacity as credentialing coordinator or credentialing specialist
  • FQHC credentialing experience is a plus.
  • CPCS or CPMSM certification highly preferred or working towards certification(s)
As a condition of employment, we require that all staff are fully vaccinated against flu. Therefore, if hired during flu season (typically between September-May), all new employees need to be fully vaccinated against flu and are required to provide documentation of receiving flu vaccines upon hire.

Zufall Health an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, medical conditions related to pregnancy or childbirth, protected veteran status, or any other characteristic protected by law. Thank you for taking the time to apply

Other details
  • Job Family Non-Clinical
  • Pay Type Hourly
  • Min Hiring Rate $20.50
  • Max Hiring Rate $27.65


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