Credentialing Specialist

BerryDunn • Remote,

1d • $56,000 - $61,000 • Remote

About The Position

BerryDunn is seeking a Credentialing Specialist to join its Healthcare Compliance and Credentialing Practice Area. Under the supervision of the Credentialing leadership team, this role handles all aspects of provider credentialing and re-credentialing, including reviewing applications and documents, submitting requests for consideration, processing initial and revalidation applications, preparing approval, denial, and termination letters, performing primary source verification, managing enrollment and re-enrollment, maintaining CAQH profiles, and accurately entering provider information into the credentialing database. The Specialist works with Credentialing leadership and the broader team to meet client needs and contractual obligations. The position is planned to be remote and requires minimal travel, less than 10% per year.

Requirements

• High school education required.
• Two to three years of relevant healthcare experience, including specialized credentialing and/or medical billing skills.
• Ability to work independently and as part of a team.
• Strong organization and time-management skills to manage priorities and deadlines.
• Effective verbal, interpersonal, and written communication skills.
• Strong attention to detail and quality.
• Proficiency with Microsoft Office, including Word, Outlook, and Teams, and Adobe.

Nice To Haves

• Bachelor’s degree preferred.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Service Management (CPMSM) certification is a plus.
• Excel proficiency preferred.

Responsibilities

• Complete credentialing and re-credentialing applications for physicians, ancillary providers, and facilities or groups with third-party payers and governmental programs, including Medicare and Medicaid, accurately and on time.
• Perform primary source verification, including verification of licenses, malpractice, and work history, and conduct PSV file audits as requested.
• Complete, update, and maintain providers’ CAQH profiles.
• Maintain the credentialing database in accordance with company policies and procedures, including payer identification numbers and effective dates for participating and non-participating providers.
• Partner with client liaisons, including billing departments, to update provider enrollment status.
• Contact payers to follow up on submitted applications in accordance with company policies.
• Respond professionally and promptly to inquiries and information requests from physicians, staff, hospitals, and managed care companies.
• Communicate with providers or their designees to obtain credentialing information needed to complete and submit required documents on time.
• Update clients regularly on progress and communicate delays.
• Keep Credentialing leadership informed of project status and help manage expectations regarding deliverables and deadlines.
• Accurately and promptly record billable and non-billable hours in time and attendance software for billing purposes.

Benefits

• Eligible employees have access to benefits supporting physical, mental, career, social, and financial well-being; specific benefits are not detailed in the posting.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED