Credentialing Specialist

1 month ago

Reading, Pennsylvania, United States Apis Services, Inc. Full time
Credentialing Specialist Job Description

The Credentialing Specialist plays a vital role in maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare, and Medicaid. This position requires strong organizational skills, attention to detail, and the ability to manage workloads effectively to meet set deadlines.

Key Responsibilities:
  • Maintain individual provider files with up-to-date information to complete required governmental and commercial payer credentialing applications.
  • Update internal provider grids to ensure accurate information and login availability.
  • Apply for and renew annually all provider licenses, including Professional, DEA, and Controlled Substance licenses.
  • Complete revalidation requests issued by government payers.
  • Review potential hires for correct credentials or licenses.
  • Participate in the development of internal credentialing processes.
  • Monitor credential and licensure and advise providers on upcoming renewals.
  • Maintain records of licenses, credentials, and insurance contracts.
  • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
  • Complete re-credentialing applications for commercial payers.
  • Assist with billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
  • Maintain accurate provider profiles on CAQH, CMS, and other databases.
Requirements:
  • High School Diploma or equivalent required.
  • Credentialing experience in Behavioral Health services.
  • Experience with National Provider Enumeration System (NPPES), CMS, I&A, and PECO's, CAQH Proview, Navient, Delaware Medicaid Portal (DMES).
  • Excellent verbal and written skills.
  • Ability to be a team player.
  • High level of attention to detail with exceptional organizational skills.
  • Knowledge of healthcare billing operations.
  • Able to work independently with minimal supervision and to set priorities in the completion of daily tasks and project deadlines.
  • Assists in managing the flow of information between payers.
  • Demonstrated skills in problem-solving, analyzing, and resolution.
  • Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information.
  • Ability to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
  • Capacity to work under pressure.
  • Ability to excel with change and respond appropriately even in challenging situations.
Required Skills:
  • Ability to deal with diverse populations.
  • Ability to stay within boundaries of the role and function of position.
  • Critical thinking skills.
  • Organizational skills.
  • Communication skills.
  • Ability to evaluate and comprehend techniques, procedures, and changes to meet variable situations.
  • Able to effectively communicate with supervisors and directors to improve his/her skills and adapt to Agency culture and policies.
  • Facilitate organizational change; has ability to understand, relate with, and adapt to different cultural settings; and demonstrates good judgement and maturity.

Apis Services, Inc. provides a progressive platform for delivering Shared Services to Imperium and its Constellation of affiliate companies. Allowing these entities to advance their mission and vision. By exploring geographical program expansion and focusing on quality outcome measures to create cost savings that result in reinvestment into the organizations stakeholders through capacity creation and employee compensation betterments.

Apis Services, Inc. and affiliates provide equal employment opportunities for all employees and applicants for employment in compliance with all federal and all applicable state and local laws and regulations, including nondiscrimination in hiring and employment. All employment decisions are made without regard to race, color, religion, gender, national origin, ancestry, age, sexual orientation, gender identity and expression, disability, genetic information, marital status, pregnancy/childbirth, veteran status or any other basis protected by law.

This policy of non-discrimination and equal employment opportunities extends to every phase and aspect of hiring and employment.

The hourly rate range for this position is $20-$25 per hour.

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