Credentialing Specialist Job at South Heart Clinic, Harlingen, TX

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  • South Heart Clinic
  • Harlingen, TX

Job Description

Credentialing Specialist

Position Summary:  This position is responsible for managing provider enrollment, credentialing, re-credentialing, and enrollment for multiple providers. The position maintains up-to-date data for each provider in credentialing databases and online systems and ensures timely license and certification renewals.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
  • Oversees the accurate collection of provider documents and information needed to contract and credential providers with insurance plans.
  • Responsible for submitting initial and recredentialing applications to payers.
  • Manages multiple provider CAQH profiles, responds and completes attestations and verification related to providers.
  • Monitors applications and follows up as required and is able to respond to provider and department leadership related to the status of applications.
  • Identifies and maintains relationships with payer representatives to assist in any issues.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Stay current on health plans.
  • Tracks license, DEA and professional liability expirations for providers.
EXPERIENCE:
Two years of relevant payer enrollment, as well as CAQH and managed care contracting experience, is preferred.
SKILLS:
  • Knowledge and understanding of the credentialing process.
  • Ability to organize and prioritize work and manage multiple priorities.
  • Excellent verbal and written communication skills, including letters, memos, and emails.
  • Excellent attention to detail.
  • Ability to research and analyze data.
  • Ability to work independently with minimal supervision.
  • Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
  • Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

 

Job Tags

Full time, Contract work, Work at office,

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