JOB TITLE: Credentialing Specialist
JOB PURPOSE: Responsible for all aspects of agency credentialing and re-credentialing with insurance companies.
ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:
- Complete all application forms, materials, and submissions for the insurance company.
- Handle all communication and correspondence with insurance representatives and network management teams.
- Setting up EFT, EDI/ERA enrollments (if applicable).
- Conduct rate negotiations.
- Submit network appeals in the event of network participation denials.
- Will maintain a data base of all participating insurance plans/provider.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Set up and maintains provider information online credentialing databases.
- Track and monitor processing and completion of applications at all hospitals.
- Maintain credentialing.
- Other duties as assigned.
- Exhibit positive customer service behavior in everyday work interactions.
- Demonstrate a courteous and respectful attitude to external customers and internal personnel.
- Communicate accurately and appropriately.
- Handle difficult situations in a discreet and professional manner.
- Hold self-accountable for professional practice.
- Maintain the confidentiality of clients and agency information.
- More behavioral standards may be developed as this role expands.
- Mental health agency credentialing, 1 year (Preferred)
- High School Diploma or GED required; Associates degree or Bachelor’s degree in a healthcare related field preferred
- Medical staff services certification:
- Certified Professional Medical Services Management (CPMSM) or
- Certified Provider Credentialing Specialist (CPCS)
BENEFITS & ADDITIONAL INFORMATION:
- Work from home
- Be your own boss
- Set your own schedule
- Contractual position
- Pay per completed application
- Growth opportunity
Send your resume or questions to: email@example.com. No phone calls please.