Credentialing Specialist

Responsibilities

• This person will be responsible for managing and maintaining provider credentialing and enrollment processes to ensure compliance with regulatory standards and policies
• Process provider credentialing and re-credentialing applications according to established guidelines and timelines
• Verify provider information including education, training, licensure, and certification
• Monitor and track credentialing and re-credentialing status to ensure timely completion and compliance with regulatory standards
• Maintain accurate and complete provider credentialing and enrollment records in accordance with regulatory requirements
• Communicate with providers and third-party payers to obtain missing or incomplete information
• Coordinate with internal departments and external organizations to ensure timely processing of provider enrollment applications
• Respond to inquiries from providers, payers, and other stakeholders regarding credentialing and enrollment status
• Monitor changes in regulatory requirements related to provider credentialing and enrollment and ensure compliance
• Identify and implement process improvements to enhance the efficiency and accuracy of credentialing and enrollment processes

• 2-3 years of experience in medical credentialing and enrollment
• Proficient in Microsoft Office applications, including Word, Excel, and Outlook
• MyPrint and Excel assessment must be attached to the sub
• Must be fine with making outbound calls

• Verifiable experience
• Athena EMR experience
• Medicare experience