CREDENTIALING SPECIALIST

Southern Colorado Clinic PC•Pueblo, CO

16h•$18 - $28•Onsite

About The Position

This position is required to perform all duties of the Credentialing and Payor Enrollment Specialist. This position will be responsible for credentialing individual, facility, and/or ancillary medical providers to ensure all initial credentialing, subsequent credentialing, and internal requirements are met and maintained as required with licensing board, hospitals, certification agencies, training programs and medical groups, practitioners, commercial payers, Medicare, and Medicaid. The Credentialing and Payor Enrollment Specialist also maintains excellent relations and liaison between payers, clinics, and providers to assist in ensuring participation status is managed in a timely and accurate manner.

Requirements

High School Diploma or equivalent required.
At least two (2) years of Medical Credentialing experience.
At least two (2) years of experience in a medical practice business office role required.
Extremely knowledgeable of credentialing and the direct impact on the revenue cycle.
Knowledge of medical terminology.
Ability to multitask.
Strong ethical code of conduct.
Ability to maintain sensitive confidential information.
Proficiency with computers and EMR software.
Autonomous, positive mindset and team player.
Ability to remain motivated with a positive attitude.
Disciplined, organized, and detail oriented.
Willingness to learn and adapt.
Ability to work with all levels of management and staff in a professional capacity.

Nice To Haves

Associate Degree preferred.

Responsibilities

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.
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
Update each provider’s CAQH database file timely according to the schedule published by CMS.
Apply for and renew annually all provider licenses; Professional, DEA, and Controlled Substance.
Complete revalidation requests issued by government payers.
Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
Complete re-credentialing applications for commercial payers.
Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
Work closely with the Business Office Manager and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
Maintain work area in a clean, sanitized, and organized manner.
Follows all Infection Prevention policies and procedures.
Attends annual required company programs and trainings.
Attends all regular required department and company meetings.
Maintains strictest confidentiality.
Performs all other tasks and projects assigned.