Credentialing Specialist (70433)

VARIETY CARE INC•Oklahoma City, OK

26d•Onsite

About The Position

The Credentialing Specialist collects and confirms provider information to process and file reports with accrediting and licensing agencies and maintains a database of provider information. The role works closely with insurance companies and government payers to provide provider and client information. The specialist manages provider initial and reappointment applications, verifies their completeness and accuracy, supports enrollment with CAQH and insurance programs, and tracks provider credentials and payer contracts. The role also maintains payer relationships and credentialing records, supports accreditation and organizational quality goals, communicates professionally with payers and coworkers, and participates in special projects and other assigned duties.

Requirements

High school diploma or GED.
Five years of administrative experience.
Experience working in a fast-paced, highly accountable environment.
Experience prioritizing, engaging in constructive feedback, and supporting quality improvement.
Expert critical-thinking, analytical, problem-solving, and decision-making skills.
Ability to communicate and interact effectively with people at various organizational levels, internally and externally, including in sensitive situations.
Proficiency with Microsoft Office and Adobe software.

Nice To Haves

Associate degree or equivalent combination of experience and education.
Medical credentialing experience.

Responsibilities

Manage initial and reappointment applications, helping providers complete paperwork on time and obtain outstanding documents and verifications by established deadlines.
Work with HR to ensure candidates submit all required documents before onboarding.
Review applications for completeness and accuracy and confirm information meets federal, state, and commercial insurance guidelines.
Ensure medical licenses, board certifications, DEA information, and other relevant credentials are renewed before expiration.
Assist with provider CAQH enrollment and federal and commercial insurance program enrollment and maintenance.
Perform other contracting and maintenance work required by payers.
Use software to maintain, track, and update insurance payer contracts across multiple practices and states.
Maintain and update credentialing insurance matrices and rosters.
Maintain relationships with payers to support improved revenue.
Follow written and verbal instructions from the Director of Revenue Cycle Management.
Communicate professionally with payers and coworkers.
Participate in special projects and perform other duties as assigned.
Support the organization's Patient-Centered Medical Home accreditation and commitment to safe, effective, patient-centered, timely, efficient, and equitable care.
Work with staff to advance the healthcare reform Triple Aim: improve care experience and health outcomes while decreasing healthcare costs.
Demonstrate personal integrity, adaptability, sound judgment, accountability, and leadership in the department and community.