Credentialing Coordinator

2 weeks ago


Baltimore, Maryland, United States nTech Solutions, Inc. Full time

Terms of Employment

  • Contract, 6 Months (Potential for Extension / Possible Conversion)
  • This position is primarily remote. Candidates must reside within a commutable distance to Baltimore, MD for occasional onsite work (trainings, team meetings, collaboration sessions, etc.) approximately once every three or four months.

Overview
nTech Solutions, Inc. is seeking a dedicated Credentialing Specialist to support the credentialing process for new practitioners aiming to participate in the organization’s Behavioral Health Network. The Specialist will be responsible for verifying provider eligibility and ensuring accurate maintenance of all provider data within the comprehensive Provider file, adhering to industry standards. This role is data-intensive and demands exceptional attention to detail, particularly in managing and reconciling data in Excel. The ideal candidate will leverage their credentialing expertise alongside advanced Excel capabilities to guarantee the precision and efficiency of the credentialing workflow.

Responsibilities

  • Process provider applications from initiation to completion, conducting twelve (12) primary source verifications for each credentialing file. Upon completion, data will be entered into the EVIP system, followed by updating a spreadsheet for downstream systems to facilitate claims department approval, ensuring seamless integration with corporate systems.
  • Address both external and internal inquiries related to provider participation eligibility, credentialing status, contractual agreements, and updates to provider files. A strong emphasis on provider experience is essential, ensuring timely resolutions, reliable follow-ups, and proactive measures to achieve successful credentialing.
  • Maintain the provider file, including the Provider Information and electronic records, with updated provider details throughout processes such as credentialing, recredentialing, demographic changes, terminations, and other maintenance activities.
  • Identify, analyze, and resolve immediate and ongoing provider file issues, processing inputs in accordance with relevant state laws and departmental guidelines.
  • Prepare written communications to obtain incomplete or missing information and engage effectively via telephone.


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