Credentialing Specialist

12 hours ago


San Antonio, Texas, United States Deery Brothers Full time
Job Overview

This position is responsible for managing provider enrollment, credentialing, and re-credentialing for multiple behavioral health providers. The role also involves investigating billing issues related to contracting and credentialing. The successful candidate will maintain up-to-date data for each provider in credentialing databases and online systems, ensuring timely license and certification renewals.

Key Responsibilities
  1. Oversee the accurate collection of provider documents and information needed to contract and credential providers with insurance plans.
  2. Submit initial and recredentialing applications to payers.
  3. Manage multiple provider CAQH profiles, respond to and complete attestations and verification related to providers.
  4. Monitor applications and follow up as required, and respond to provider and department leadership related to the status of applications.
  5. Identify and maintain relationships with payer representatives to assist in any issues.
  6. Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
  7. Stay current on current health plans and agencies within the cost centers being managed.
  8. Audit health plan directories for current and accurate provider information.
  9. Assist with department projects.
Qualifications
  1. High school diploma or equivalent.
  2. Associate degree preferred.
Experience

Two years of relevant payer enrollment, as well as CAQH and managed care contracting experience, is preferred.

Skills
  1. Knowledge and understanding of the credentialing process.
  2. Ability to organize and prioritize work and manage multiple priorities.
  3. Excellent verbal and written communication skills, including letters, memos, and emails.
  4. Excellent attention to detail.
  5. Ability to research and analyze data.
  6. Ability to work independently with minimal supervision.
  7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
  8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.


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