Credentialing Specialist (55499)

Greenfield Rehabilitation Agency/Rehab Resources•Brookfield, WI

20d•Hybrid

About The Position

Rehab Resources & Greenfield Rehabilitation is seeking a dedicated Credentialing Specialist to join their dynamic team. This role is essential for managing the credentialing and enrollment process for government and commercial payers, ensuring a smooth experience for providers. The specialist will handle initial enrollments, CAQH application monitoring, and revalidation processes, working closely with insurance provider relations, representatives, CAQH, and the internal team to resolve issues. The company emphasizes core values of Agility, Integrity, and Community, offering a supportive work environment with a focus on work-life balance.

Requirements

Proficiency in Excel, Word, and Outlook
Strong ability to multitask and take ownership of processes
Self-motivated and able to work independently
Tech-savvy and comfortable navigating multiple computer systems and screens
Ability to perform under pressure in a fast-paced environment with tight deadlines
Experience with Medicare and Medicaid Provider enrollments, including revalidations
Familiarity with insurance websites (e.g., CAQH, Waystar)
Knowledge of NCQA standards
At least 18 years of age
High school diploma or equivalent
Advanced training in medical credentialing

Nice To Haves

Understanding of the 1500 Claim Form
Experience with Clearing House systems, such as Waystar
Medical billing experience
Familiarity with credentialing software platforms
Credentialing certification (CPCS) is a plus, but not required

Responsibilities

Manage the initial provider enrollment, CAQH monitoring, and revalidation processes for both government and commercial payers.
Collaborate with insurance provider relations, representatives, CAQH, and the internal team to ensure seamless enrollments and resolve any issues that arise.
Navigate multiple systems and tasks simultaneously, ensuring accuracy and timeliness in all processes.