Payer Credentialing Specialist
1 month ago
Assemble and submit credentialing application packets, maintaining practitioner files and ensuring confidentiality of all documents.
Enroll and maintain providers in Medicare, Medicaid, Commercial, and Managed Care payers, including managing NPI applications.
Collaborate with the Medical Staff Office to ensure current credentialing documents (e.g., CVs, licenses) are maintained.
Follow up on pending applications, enter data into CAQH profiles, and ensure quarterly re-attestation.
Build relationships with provider representatives and communicate application statuses to clinic and Revenue Cycle staff.
Provide reports to payers as per credentialing agreements and address credentialing-related inquiries across departments.
Coordinate with Revenue Cycle staff on claims denials and participate in payer audits as needed.
Additional Responsibilities
- Perform other duties as assigned.
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