Credentialing Specialist - Per Diem

BerryDunn•Remote,

3h•$25 - $30•Hybrid

About The Position

BerryDunn is seeking a per diem Credentialing/Enrollment Specialist to join our Healthcare Credentialing Practice Area. Under the supervision of the Credentialing leadership team, the Specialist will be responsible for all aspects of provider and group enrollment, maintenance, credentialing/re-credentialing, including, but not limited to, CAQH activities, special projects, verification of application/documents, submission of enrollment or credentialing requests for consideration, initial and revalidation applications, approval, denial, termination letters, primary source verification (PSV) activities, and accurately loading provider information into the Credentialing database. The Credentialing Specialist works closely with the Credentialing leadership on servicing the client needs and meeting contractual obligations. The Credentialing Specialist will need to be available to provide support to clients and the team during the business day; evening and weekend hours may be requested or required as client and project needs arise. This position is planned to sit in our New Haven office location or remotely. Travel Expectations: This role requires minimal travel, less than 10% per year.

Requirements

High school education required, bachelor’s degree preferred
3-5 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), Certified Professional in Medical Staff Service Management (CPMSM), or Certified Provider Enrollment Specialist (CPES) certification a plus

Responsibilities

Complete enrollment and/or re-enrollment, revalidation 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