Payer Credentialing Specialist

5 days ago


Irving, Texas, United States Exceed Healthcare Full time
About the Role

We are seeking a highly skilled Payer Credentialing Specialist to join our team at Exceed Healthcare. As a key member of our HR department, you will be responsible for ensuring that all medical providers who provide patient care as clients of Exceed Healthcare are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities.

Key Responsibilities
  • Compile and maintain current and accurate data for all providers.
  • Complete provider credentialing and re-credentialing applications, monitor applications, and follow up as needed.
  • Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
  • Maintain knowledge of current health plan and agency requirements for credentialing providers.
  • Set up and maintain provider information in online credentialing databases and systems.
  • Track license and certificate expirations for all providers to ensure timely renewals.
  • Ensure practice addresses are current with health plans, agencies, and other entities.
  • Process applications for appointment and reappointment of privileges for providers who are clients of Exceed Healthcare.
  • Track license, DEA, and professional liability expirations for appointed Exceed Healthcare providers.
  • Maintain Exceed Healthcare client appointment files and information in credentialing databases.
  • Set up and maintain provider information via CAQH.
  • Access PHI/EPHI in direct relation to patient care.
  • Manage the completion and submission of initial provider malpractice insurance applications.
Payer Credentialing
  • Perform follow-up with insurance payers via phone, email, or website to resolve payer credentialing issues.
  • Work closely with external payer credentialing vendors on notification of a provider's start, welcome packets, provider documentation, and ensuring the provider is in all systems.
  • Manage the completion and submission of provider enrollment applications.
  • Perform tracking and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner.
  • Understand specific application requirements for each payer, including prerequisites, forms required, form completion requirements, supporting documentation, and regulations.
  • Maintain documentation and reporting regarding provider enrollments in process.
  • Retain records related to completed payer credentialing applications.
  • Update insurance programs with location change information within 90 days of change.
  • Ensure accounts, PTAN, and other identifying numbers remain active.
  • Diligent follow-up with insurance companies throughout the application process.
Additional Responsibilities
  • Maintain confidentiality of provider information.
  • Provide credentialing and privileging verifications.
  • Perform other duties and special projects as assigned.
What We Offer
  • PTO package for all non-clinical full-time employees.
  • Training.
  • Health, dental, vision benefits.
  • 401k.
  • Growth opportunities.

We are an equal opportunity employer and welcome applications from qualified candidates without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.



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