Credentialing and Licensure Specialist
3 days ago
The Credentialing & Licensure Specialist plays a critical role in maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, and commercial payers.
Key Responsibilities- Maintains compliance with all regulatory and accrediting institutions, ensuring seamless operations.
- Manages individual provider files, ensuring up-to-date information is readily available to complete required governmental and commercial payer credentialing applications.
- Maintains CE hours to ensure compliance with state regulations, guaranteeing the highest level of professionalism.
- Applies for and renews all provider licenses, ensuring timely and accurate processing.
- Completes revalidation requests issued by government payers, ensuring providers remain active and compliant.
- Completes credentialing applications to add providers to commercial payers and re-credentialing applications for commercial payers, streamlining the process.
- Partners with Clear Choice to ensure credentialing of new providers and re-credentialing current providers, fostering collaboration and efficiency.
- Maintains provider credentials with hospitals at which they hold staff privileges, ensuring accurate and up-to-date information.
- Facilitates Integration of Acquisition and required processes, ensuring a smooth transition.
- Works closely with the Revenue Cycle team to identify and resolve any denials or authorization issues related to provider credentialing, ensuring seamless operations.
- High School Diploma or equivalent required.
- Associates degree in a related field preferred.
- Two or more years of relevant experience required.
- Credentialing experience preferred.
- Knowledge of provider credentialing and compliance.
- Excellent computer skills, including Excel, Word, and Internet use.
- Detail-oriented with above-average organizational skills.
- Excellent customer service skills.
- Excellent written and verbal communication skills.
- Ability to plan, prioritize, and meet deadlines.
Paradigm Oral Health offers a comprehensive benefits package, including:
Medical (including Virtual Care), Dental, and Vision Coverage
Employee Assistance Program (EAP)
Financial Well-Being
Competitive pay, Bonus potential, and annual merit reviews
401(k) Plan w/Company Match
Health Savings Account (HSA) with HDHP health plans
Life Insurance
Basic and Supplemental Life Insurance
Spouse and Child Life Insurance
Time Off, Disability And Leave Of Absence
Paid Vacation (Starting at 2 weeks) and 6 Annual Paid Holidays
Long and Short Term Disability Plans
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