Credentialing Specialist
New
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LifeMDHealthcare Technology
United StatesFull-TimeMiddle
Salary60,000 - 70,000 USD per year
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Job Details
- Experience
- 2+ years
- Required Skills
- Data Analysis
Requirements
- Bachelor’s degree in Business Administration, Healthcare Administration, or equivalent experience.
- 2+ years of relevant experience in credentialing and administrative functions.
- Credentialing Certification required.
- Certified Provider Credentialing Specialist (CPCS), Certified Medical Services Management (CPMSM), or Certified Provider Enrollment Specialist (CPES) preferred.
- Expertise in credentialing, multi-state licensing, and multi-state payor enrollment functions.
- Proficiency in credentialing software with an ability to adapt to new systems.
- Strong knowledge of healthcare regulations and compliance requirements.
- Excellent analytical skills to interpret and act on complex data.
- High level of communication skills (written, verbal, and conceptual presentation).
- Strong organizational, time management, and attention to detail skills.
Responsibilities
- Credential and re-credential providers with insurance payors and hospitals.
- Maintain and update insurance credentialing and the CAQH Provider System.
- Manage credentialing matrices for all providers and markets.
- Facilitate the onboarding and offboarding of providers in collaboration with other departments.
- Assist providers with ancillary credentialing, licensing, or payor enrollment questions.
- Obtain necessary licensure and privileges for providers.
- Perform external research and verification of provider licensure, malpractice, and educational credentials.
- Monitor insurance payor websites for accurate directory listings and perform updates.
- Create and maintain provider credentialing rosters.
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