Credentialing Specialist – Coordinator
Posted 4ds ago
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Job Description
Remote part-time credentialing specialist maintaining provider credentials and payer enrollment for a Massachusetts health center. Managing CAQH, PECOS, MassHealth, Medicare, Medicaid, and commercial payer documentation.
Responsibilities:
- Support providers through the privileging and credentialing process at acceptance of employment
- Initiate hospital credentialing for physicians and collaborate with UMass to maintain physician hospital appointments
- Maintain internal provider IDs, rosters, provider information, and NPI/PECOS access
- Support providers with applying for and renewing professional, DEA, controlled substance, and other required practice licenses and documentation
- Perform primary source verifications required by CMS, HRSA, Joint Commission, and NCQA
- Facilitate compliance trainings, CME's, and Life Support Trainings
- Re-credential providers for the Health Center and UMass
- Maintain accurate provider credentialing profiles in Cactus Cred software
- Track and report monthly on credentialing expirables
- Complete MassHealth and PECOS revalidation requests
- Complete credentialing applications for commercial payers, Medicare, and Medicaid
- Track and report provider enrollment progress
- Initiate and maintain provider CAQH database files according to CMS schedules
- Complete re-credentialing applications for commercial payers
- Collaborate with the Revenue Cycle Director and billing staff to resolve credentialing-related denials and authorization issues
- Create and maintain provider profiles in CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases
- Perform other duties as assigned
Requirements:
- High school diploma, GED, associate degree, or bachelor's degree
- 2 years of credentialing experience preferred
- 2 years of experience in a medical practice business office role required
- Knowledge of provider credentialing and provider enrollment and their impact on the practice's revenue cycle
- Excellent computer skills, including Excel, Word, and Internet navigation for state and federal sites and health-plan searches
- Detail-oriented with strong organizational and time-management skills
- Ability to plan and prioritize to meet deadlines
- Excellent customer service skills
- Clear, effective, and professional communication
Benefits:
- Facilitate/support providers in obtaining compliance trainings, CME's, and Life Support Trainings when due
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