Credentialing Specialist

3 weeks ago

Remote, United States Element RCM Full time
*Job Mission*

A Credentialing Specialist’s primary job is to ensure that the personnel of a facility, mainly

healthcare, are properly trained, licensed and certified as mandated by state and federal

regulations. In addition, they ensure that all services offered by these industries meet

standards set by state and federal government agencies. A Credentialing Specialist would

review applications, verify both individual and facility accreditation, maintain records of

verification and work with auditors as needed. The Credentialing Specialist must comply with

applicable laws regarding credentialing standards and be able to operate with the highest

integrity without compromise.

*Essential Job Duties*

● Maintain individual provider files to include up to date information needed to complete

the required governmental and commercial payer credentialing applications

● Maintain internal provider grid to ensure all information is accurate and logins are available

● Update each provider’s CAQH database file timely according to the schedule published by CMS

● Apply for and renew annually all provider licenses; Professional,

● Complete revalidation requests issued by government payers

● Complete credentialing applications to add providers to commercial payers and Medicaid

● Complete re-credentialing applications for commercial payers

● Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing

● Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases

● Other duties as assigned

*Required Skills and Abilities*

● Ability to balance multiple competing priorities, to self-direct time, and meet deadlines

● Flexibility and ability to embrace change and seek feedback with a growth mindset

● Resilience and ability to remain calm under pressure and job related stress such as client complaints or short term deadlines

● Ability to learn new concepts quickly and willingness to self-direct continuous learning

● Exhibit a positive and compassionate attitude

● Ability to work efficiently and professionally from your home office

● Exhibit playfulness and innovation in your day to day work

● Demonstrate high integrity in every action, and believe that integrity is a choice

● Experience in a fast-paced, high-impact service environment

● Demonstrated proficiency with technology that enhances your productivity and customer experience (e.g. EMR, CRM software, practice management, Google Suite)

● Demonstrate proficiency with revenue cycle management activities

● Communicate effectively and proactively with multiple stakeholders to ensure high quality service delivery and problem resolution

● Ability to manage multiple insurance provider codes, requirements and authorizations for proper scheduling and billing per Element policy and contractual agreements

*Education, Experience and Certifications*

● Minimum highschool degree

● Minimum 3 years experience of credentialing on multi-state, multi-entity scale

● Demonstrated proficiency with technology that enhances your productivity and customer experience (e.g. EMR, CRM software, practice management, Google Suite)

● Demonstrate proficiency with revenue cycle management activities

● Able to pass a background check and qualified to work in the US

*Physical Requirements*

● While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.

● Regularly required to talk and hear.

● Regularly required to remain in a stationary position for long periods of time.

● Specific vision abilities required by this job include close vision, and ability to adjust focus while utilizing computers for long periods of time.

*Reporting*

You will report to the Team Lead.

_This job description is not all inclusive, and is subject to change. You may be asked to perform_

_additional duties in support of the organization._

Job Type: Full-time

Schedule:
* Monday to Friday

Application Question(s):
* Do you have experience credentialing Board Certified Behavior Analysis?
* Do you have experience in commercial payers & Medicaid?
* In which previous position(s) did you practice the above skills on a regular basis?
* Do you have experience credentialing mental health providers and psychologists?

Work Location: Remote

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