Credentialing Specialist

2 days ago


Austin, Texas, United States PT Solutions Physical Therapy Full time
Job Overview & Responsibilities:

The Credentialing Specialist is responsible for ensuring seamless payer participation with government and commercial health plans. This role involves obtaining and maintaining enrollment with various payers, resolving enrollment issues, and coordinating with internal teams to facilitate timely claims payment.

Key Functions:
  • Manage the completion, submission, and re-credentialing of provider enrollment applications.
  • Track application status, follow up as necessary, and document activity in a timely and accurate manner.
  • Prepare and submit CAQH profiles for newly affiliated and existing providers.
  • Research and resolve provider-related enrollment issues, collaborating with team members as needed.
  • Maintain confidentiality of provider information and ensure secure storage of sensitive data.
  • Update and maintain provider files, including internal data, CAQH profiles, payer databases, and Medicare records.
  • Assist providers with application completion and credentialing paperwork.
  • Communicate effectively with management and billing operations staff to resolve credentialing-related issues.
  • Review provider credentialing files, identify missing or incomplete information, and work with providers to obtain necessary documents.
  • Stay up-to-date on current health plan and agency requirements for credentialing providers.
Qualifications & Pay Range:

This role requires a strong understanding of medical reimbursement and terminology, as well as excellent communication and organizational skills. The ideal candidate will have experience with CAQH Proview, Microsoft Excel, and other relevant software applications.

Required Skills & Abilities:

  • Ability to type 60 words per minute.
  • Physician and payer credentialing experience.
  • Excellent customer service skills.
  • Strong interpersonal, oral, and written communication skills.
  • Ability to manage multiple priorities and meet deadlines.
  • Complete understanding of medical reimbursement and terminology.

Required Credentials:

  • High School Diploma.
  • Minimum two years of experience in credentialing for managed care insurance enrollment, Medicare, and Medicaid.
  • Working knowledge of CAQH Proview.
  • Knowledge of payer credentialing process and ability to prioritize work effectively.


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