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Provider Credentialing Specialist
2 weeks ago
We are seeking a detail-oriented Provider Credentialing Specialist to join our organization.
The ideal candidate will possess a strong background in provider enrollment, comprehensive understanding of the credentialing process, and excellent communication skills.
Key Responsibilities:
- Provider Enrollment & Application Management:
- Demonstrated expertise in the end-to-end provider enrollment process.
- Proficiency in accurately completing a high volume of provider applications across various specialties and payer types.
- Ensuring timely and efficient submission of all completed applications to relevant entities.
- Tracking application statuses and proactively following up on outstanding items to expedite approval.
- Welcome Kit Generation & Contract Loading:
- Responsible for the creation and dissemination of comprehensive Welcome Kits for new providers, ensuring all necessary documentation and information is included.
- Accurate and efficient loading of provider contracts into the designated system, ensuring all terms and conditions are correctly captured.
- Application Portal Expertise:
- Extensive experience in creating and managing accounts within key healthcare application portals, including CAQH, Medicaid, Medicare (PECOS portal), NPI, and regional specific portals.
- Communication & Responsiveness:
- Maintain a high level of professionalism and responsiveness in all email communications, promptly addressing queries and providing clear, concise information to internal and external stakeholders.
- Compliance & Confidentiality:
- Strictly adhere to all HIPAA regulations and maintain the utmost confidentiality of sensitive patient and provider information.
- Ensure all credentialing activities are in full compliance with federal, state, and organizational guidelines.
Required Skills and Qualifications:
- Bachelor's Degree (Preferred) in a relevant major such as Healthcare Administration, Health Information Management (HIM), Business Administration, or Public Health.
- An associate's degree combined with relevant work experience may suffice for entry-level roles.
- Experience:
- Expertise in provider enrollment and credentialing processes, ensuring ethical and accurate completion and submission of applications across various specialties and payers.
- Proficiency in managing accounts in key healthcare application portals with a commitment to ethical standards in data handling.
Key Competencies:
- Communication: Clear, professional, and ethical verbal and written communication; highly responsive in emails to foster trust.
- Organization: Track application statuses and ensure timely submissions with diligence, supporting a high-performance culture.
- Independence & Teamwork: Work autonomously with ethical initiative and collaborate effectively to drive team excellence.
- Attention to Detail: Accurate application and contract management, reflecting commitment to quality and ethical precision.
This role demands a detail-oriented professional with a strong ethical foundation, technical proficiency, and a drive for performance excellence in credentialing.
