Credentialing Specialist

Overview

Compensation Range: 37,336.00 to 77,542.40

The Credentialing Specialist reports to the Credentialing Manager and is responsible for timely submission and follow-up of payer enrollment applications and credentialing applications for appointment and re-appointment to hospitals and Ambulatory Surgery Centers (ASCs).

• Add, update and maintain accurate provider information in CAQH, Credential Stream and other tools commonly utilized for credentialing and payer enrollment
• Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding
• Complete, submit, document and pro-actively track and follow-up on required credentialing, enrollment and re-credentialing applications, paying close attention to details
• Gather, compile and continuously monitor information necessary for enrollment and credentialing purposes
• Update and inform department and other leadership of progress and issues using various means of communication
• Research and respond to internal and external inquiries related to enrollment and credentialing issues
• Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for both facility credentialing applications and payer enrollment submission
• Work collaboratively in a team environment to achieve team and organizational goals by sharing information and resources
• May assist other team members with the provider licensing and renewal process
• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity
• Miscellaneous job-related duties as assigned.

Compensation range is $ 37,336.00 to 77,542.40

PRISM Vision Group is an Equal Opportunity / Affirmative Action employer. Candidates are selected solely on the basis of legally permissible job-related criteria without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

Education
:
Bachelor's degree, additional experience in lieu of education is accepted.

Experience
: 3-5 years of experience in a medical service profession, payer enrollment, insurance plan, revenue cycle, or a combination.

Knowledge/Skills/Experience

• Must be accountable, organized and work independently to self-manage assignments
• Knowledge and understanding of the credentialing process; ability to apply principles, procedures, requirements, regulations and policies
• Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders
• Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools
• Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift
• Express thoughts and information clearly, concisely and effectively both verbally and in writing
• Critical thinker, anticipating next steps
• CPCS certified a plus
• Experience with Credential Stream preferred
• Computer Proficiency, Microsoft Office to include Word, Excel, Power Point