Job Description

Job Duties

Maintain organized and accurate files to ensure the credentialing is obtained from all physician and non-physician providers.
Timely and appropriately apply for, process, submit, and maintain credentials and licensing with insurance companies and federally subsidized government plans, such as Medicare and Medicaid
Ensure that all insurance companies have current and accurate information they need to process claims in a timely manner.
Verify compliance of all documents prior to submission.
Communicate effectively with clients on payer registration status and updates.
Build and maintain relationships with payer representatives.
Proactively identify and resolve any issues a client may face during the payer registration process.
Demonstrate self-management behaviors and being a self-starter, following established policies and procedures and promote an efficient, cost-effective work environment.
Keep RCM Account Managers, Supervisors and management, and providers informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, etc. to prevent delayed claims filing and cash flows.
Sets up and maintains provider information in online credentialing databases and system
Track license and certification expirations for all providers to ensure timely renewals

Job Requirements

1-2 years of insurance credentialing experience including federal government plans
Certified Provider Credentialing Specialist (CPCS) preferred
Hands-on knowledge of the credentialing process
Strong written and oral communications skills
Working knowledge of Medical Terminology.
May require some travel
Experience working directly with providers
Microsoft Office Suite
Ability to work in a fast-paced environment

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Credentialing Specialist I