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.
