Credentialing Specialist

We are a leader in specialized pediatric orthotics, proud of our top clinicians, technicians, and administrative staff, led by an executive team dedicated to advancing the orthotics and prosthetics profession.

The Contracts and Credentialing Specialist is responsible for timely enrollment of new payors and ongoing maintenance of existing payors. This role requires a desire to develop and follow process, strong attention to detail, and excellent communication skills to convey information to payors and cross-functionally within the organization.

• Prepare credentialing and re-credentialing applications on behalf of BOP clinics and providers for submission to payor contracting entities.
• Accurately review new enrollment files for deficiencies and perform follow-up on delinquencies.
• Responsible for ongoing maintenance of existing BOP locations/clinics and providers, including submission of maintenance update forms, weekly expirables, and tracking of licenses, certifications, and surety bonds.
• Research and solve credentialing/re-credentialing delays and issues with contracting entities in a timely manner.
• Maintain provider enrollments: prepare BOP clinic and provider applications, staff rosters, re-enrollment, and terminations forms, and submit them to 3rd party insurance plans.
• Work with clinics and providers: communicate enrollment requirements, complete applications, verify information, and obtain signatures.
• Maintain credentialing, enrollment, and web portal access tasks in billing systems.
• Maintain insurance web portal access, adding/removing users as needed.
• Maintain data: enter and update clinic and provider information in billing systems and department databases.
• Follow timely processes: produce status reports and tracking spreadsheets.
• Coordinate with managers: clarify provider start dates, practice locations, specialty areas, privileges, and enrollment status.
• Prepare and submit facility/clinic and provider applications to 3rd party insurance plans, Medicaid, and Medicare.
• Ensure all information meets federal and state guidelines when processing applications.
• Keep a facility's/clinic and provider accreditation up to date and assist with audits.
• Compile and maintain current and accurate data for all clinics and providers.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all clinics and providers.
• Open incoming mail and distribute accordingly.
• Access confidential and secure federal, state, and private databases as needed to complete assignments.
• Triage billing calls and send messages to appropriate CBO members for completion.
• Post insurance and patient refunds (via check) into billing systems.

• Three to five years' experience in credentialing or healthcare preferred.
• Excellent interpersonal skills, including the ability to communicate written and verbally with individuals at all levels in a clear, succinct manner.
• Understanding of Medicare and Medicaid reimbursement methodologies and community health reimbursement healthcare services and contracting methodology.
• Knowledge of ICD-10 and how E&M coding translates into CPT codes desired.
• Results-driven, able to self-direct, and work independently as well as perform in a team environment.
• Ability to multi-task, organized, pay close attention to details, and be flexible in a fast-paced organization.