Medical Credentialing Specialist

Tareen Dermatology Pa•Roseville, MN

2d•Hybrid

About The Position

Tareen Dermatology is hiring a full-time, non-exempt Medical Credentialing Specialist. The role is responsible for credentialing and re-credentialing current and future practitioners, credentialing practitioners and locations with payers, and keeping licenses and related documents active and current. The position is primarily remote, but candidates must live in the Twin Cities Metro and be available for occasional on-site meetings. The specialist coordinates credentialing submissions and follow-up with insurance payers, tracks progress for new hires and clinic locations, maintains credentialing records and payer contacts, updates practitioner information, and supports the resolution of credentialing and insurance issues. The role also requires following HIPAA and OSHA policies and keeping job knowledge current through educational opportunities. The work is performed primarily in a computer-based environment, with prolonged sitting and screen use, frequent communication by phone, video, and electronic messaging, and regular operation of a computer and office equipment. Occasional on-site meetings and physical activities such as standing, walking, reaching, balancing, stooping, kneeling, or crouching may be required. The position requires the ability to lift or move items up to 10 pounds occasionally and specified visual abilities, including close, distance, color, peripheral, and depth perception and the ability to adjust focus.

Requirements

High school diploma or equivalent.
1–2 years of experience in a credentialing role within a healthcare setting.
Prior credentialing experience within a medical office or clinic.
Proficiency in typing, spelling, punctuation, grammar, and oral communication.
Ability to manage multiple priorities and prioritize tasks effectively.
Detail-oriented and highly organized.
Ability to follow oral and written instructions.
Strong computer skills and ability to navigate Practice Management and EHR systems.
Ability to work independently and as part of a team.
Ability to communicate calmly and clearly with payers and others by phone and in person.
Must live within the Twin Cities Metro and be available for occasional on-site meetings.
Ability to lift or move items up to 10 pounds occasionally.
Ability to perform the visual functions specified for the role: close, distance, color, peripheral, and depth perception, and adjustment of focus.

Nice To Haves

Previous dermatology experience.

Responsibilities

Credential and re-credential current and future practitioners.
Credential and re-credential practitioners for dispensary services.
Submit required documents to insurance payers in a timely manner.
Submit payer change request forms for new hires with sufficient lead time for credentialing before their start dates.
Coordinate location credentialing for new clinics.
Create and maintain credentialing progress logs for new hires with pending credentialing.
Maintain an up-to-date credentialing contact list for each insurance plan.
Update practitioner NPI information on NPPES as needed.
Obtain and verify updated medical licenses, DEA certificates, and board certifications from practitioners.
Send current malpractice and license documents to insurance payers before document expiration.
Terminate former practitioners from payer networks as appropriate.
Update and distribute insurance lists as changes occur.
Troubleshoot credentialing and insurance issues with billing and insurance staff and the supervisor as needed.
Maintain job knowledge by participating in educational opportunities.
Follow HIPAA and OSHA policies.
Perform other duties as assigned.