Credentialing Specialist I

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.