Job Description

Job Title: Credentialing Specialist

Department: Credentialing and
Enrollment

Job
Purpose and Position Overview:

Team Leader responsible for
the performance, productivity and effective management of team members of
Credentialing. He would ensure that the providers of a group are properly
licensed and certified as mandated by state and federal regulations to credential
& contract them with insurance carriers. The Team Leader would report to
Asst. manager & is responsible to maintain smooth client relationship.

Specific Job Duties &
Responsibilities:

1.      List key Duties & Responsibilities

1.      Completion and submission of provider
enrollment applications to payers

2.      Update mailing/physical address.

3.      Registration of payers’ provider web portal
access.

4.      Maintenance of documentation and reports
regarding provider enrollments in process.

5.      Retain records related to completed provider
enrollments

6.      Maintain provider enrollment information
within the credentialing database.

7.      Interact with plan representatives by phone or
email to provide appropriate and timely response to inquiries and concerns regarding
provider.

8.      Respond to client inquiries regarding status
of applications received.

9.      Proactive follow up with insurance plans to
monitor status of provider applications.

1.  Resolve enrollment application deficiencies.

2.      List of general Duties/Responsibilities

1.      Maintain strict confidentiality of information
as per current HIPAA requirements.

2.      Collaborate with leadership and teammates on
process improvement.

3.      Get tasks done by using all of the resources
available.

4.      Actively Participate in client and team meetings.

5.      Manage credentialing work orders, tickets to
ensure all established time frames for completing work and projects are met.

6.      Monitor provider credentials and communicate
to managers to ensure providers remain up to date with state and/or federal
regulations

7.      Audit new staff’s work and give feedbacks. 

3.       Daily
Routine:

1.      Complete work orders assigned
through tickets and emails.

2.      Follow up with the Payers to
obtain the status of credentialing application.

3.      Work on pending/in process service
tickets & project tickets. 

4.      Weekly routine:

1.      Credentialing meeting with team.

5.      Quarterly Routine:

1.      Completion of Rocks

6.      Qualifications:

1.      Any Degree

2.      Should have minimum 4+ years of
experience in Medical billing.

3.      Should have worked in various
specialties and be a motivational mentor.

4.      Good written and verbal communication skills.

5.      Good Typing skills.

6.      Regular attendance.

7.       Measures
of Performance:

1.       Performance measured by productivity &
Quality.

8.       Supervisory Responsibilities:

1.       Audit new staff’s work and give feedbacks.

9.       Training Requirements:

1.       Credentialing Activities