Credentialing & Licensing Specialist I

TeleMed2U•Austin, TX

About The Position

The primary role of this position is to assist physicians and support the Credentialing team with preparing and submitting licensing, credentialing, enrollment, recredentialing applications and follow up on the status of applications for Physicians and Payers and keep a detailed log of all tasks. The credentialing & licensing specialist will be responsible for supporting all aspects of licensing, credentialing and recredentialing and any other administration duties assigned by management. Credentialing and License Specialist 1: Supports the TeleMed2U Provider Network’s credentialing process for all TeleMed2U clinical providers, in accordance with NCQA, URAC, Joint Commission and CMS accreditation standards, Federal and State laws, and TeleMed2U’s policies. Assists with the management of TeleMed2U Provider Network’s credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process. Coordinates the management of the expirable process to ensure all clinical provider licenses and board certifications remain current, ensuring appropriate notification prior to expiration. Assist providers through the renewal licensing process Ensures all credentialing, enrollment and license applications accuracy prior to submission Monitors provider license application statuses, follow ups with various state medical boards Monitors provider enrollment application status, follow up with the payors Mains, assists in renewing and tracks license and certification expiration for providers Manage CAQH profiles for TeleMed2U’s Provider Network. Prepare and submit rosters to health insurance plans to ensure provider participation. Update various databases to ensure proper tracking of payor enrollments, credentialing and update requests. Maintain necessary records of outstanding enrollment applications and requests. Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies Maintain Credentialing database. Follow-up with managed care companies to ensure expedient credentialing. Remains current on policies affecting provider enrollment credentials & delegated clients/payers.

Requirements

Credentialing or license experience
High School Diploma or equivalent

Nice To Haves

Medicare and Medicaid enrollment experience preferred
Bachelor’s degree preferred
1-3 years of experience in licensing, payor enrollment and credentialing preferred

Responsibilities

Assist physicians and support the Credentialing team with preparing and submitting licensing, credentialing, enrollment, recredentialing applications
Follow up on the status of applications for Physicians and Payers and keep a detailed log of all tasks
Support all aspects of licensing, credentialing and recredentialing
Support all aspects of licensing, credentialing and recredentialing and any other administration duties assigned by management
Supports the TeleMed2U Provider Network’s credentialing process for all TeleMed2U clinical providers, in accordance with NCQA, URAC, Joint Commission and CMS accreditation standards, Federal and State laws, and TeleMed2U’s policies.
Assists with the management of TeleMed2U Provider Network’s credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process.
Coordinates the management of the expirable process to ensure all clinical provider licenses and board certifications remain current, ensuring appropriate notification prior to expiration.
Assist providers through the renewal licensing process
Ensures all credentialing, enrollment and license applications accuracy prior to submission
Monitors provider license application statuses, follow ups with various state medical boards
Monitors provider enrollment application status, follow up with the payors
Maintains, assists in renewing and tracks license and certification expiration for providers
Manage CAQH profiles for TeleMed2U’s Provider Network.
Prepare and submit rosters to health insurance plans to ensure provider participation.
Update various databases to ensure proper tracking of payor enrollments, credentialing and update requests.
Maintain necessary records of outstanding enrollment applications and requests.
Coordinate all managed care credentialing activities to ensure provider participation status.
Credentialing activities require substantial contact with outside agencies
Maintain Credentialing database.
Follow-up with managed care companies to ensure expedient credentialing.
Remains current on policies affecting provider enrollment credentials & delegated clients/payers.