Credentialing Specialist
About The Position
BerryDunn is seeking a Credentialing Specialist to join our Healthcare Compliance and Credentialing Practice Area. Under the supervision of the Credentialing leadership team, the Credentialing Specialist will be responsible for all aspects of credentialing/re-credentialing providers, including, but not limited to, verification of application/documents, submission of requests for consideration, initial and revalidation applications, approval, denial, termination letters, primary source verification activities, enrollment, re-enrollment, CAQH maintenance and accurately loading provider information into the Credentialing database. The Credentialing Specialist works closely with the Credentialing leadership and broader Credentialing Team to service clients’ needs and meet contractual obligations. This position is planned to be remote. Travel Expectations: This role requires minimal travel, less than 10% per year.
Requirements
- High school education required, bachelor’s degree preferred
- 2-3 years of relevant healthcare experience is required including specialized skills in Credentialing and/or Medical Billing
- Ability to work independently, as well as, in a team setting
- Exceptional organization and time management skills to manage priorities and deadlines
- Effective verbal, interpersonal, and written skills
- Strong attention to detail and quality
- Proficiency with Microsoft Office suite (Word, Outlook, Teams) and Adobe; Excel preferred
Nice To Haves
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Service Management (CPMSM) certification a plus
Responsibilities
- Complete credentialing and/or re-credentialing applications for physicians, ancillary providers and facilities or groups with third-party payers and governmental programs (Medicare and Medicaid) as requested by the client in an accurate and timely manner
- Perform Primary Source Verification (PSV) services including but not limited to verification of licenses, malpractice and work history’ perform PSV file audits as requested.
- Complete, update and maintain Council for Affordable Quality Healthcare (“CAQH”) profiles for providers
- Maintain a Credentialing database in accordance with BerryDunn’s policies and procedures for all participating and non-participating providers with payer identification numbers and effective dates
- Partner with client liaisons, including billing departments to update the enrollment status of the providers
- Contact payers to follow up on submitted applications within BerryDunn’s policies
- Respond to various inquiries and requests for information from participating physicians, staff, hospitals, and managed care companies timely and with professionalism
- Communicate with providers or their designees to obtain requisite credentialing information to facilitate timely completion and submission of required documents
- Update client regularly on process and communicate any delays
- Continuously inform Credentialing leadership of the project status and assist in managing expectations related to deliverables and deadlines
- Be responsible for timely and accurately accounting of hours (billable and non-billable) in time and attendance software for proper billing of services rendered
Benefits
- Benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
