Credentialing Specialist

Job Description

Job Description

Description :

Provider Credentialing Specialist - Iowa

We are seeking a Provider Credentialing Specialist to become a part of our team working in the urgent care / primary care setting. Your main focus will be providing high-quality, efficient provider credentialing. You will obtain licensure and credentials from providers, verify past credentials, and ensure the billing process runs smoothly.

Key Tasks and Responsibilities :

• Enroll providers with the necessary payors and the clearinghouse to ensure claims can be billed correctly.
• Handle contracting, the revalidating of Medicare and Medicaid enrollment, CAQH, and any re-credentialing maintenance.
• Responsible for collecting and confirming provider information in order to process and file reports with accrediting and licensing agencies as well as maintaining a database of provider information.
• Coordinate with our billing department to ensure that processes are in place to detect non-compliant or questionable claims.
• Review clearinghouse and claims data for rejections. Identify and correct provider credentialing issues.
• Maintain, review, and update provider credentialing with all payors. Review prior credentialing applications for errors and correct as needed.
• Assist working denials due to credentialing issues.
• Maintain MODIO provider certification system.
• Maintain CAQH profiles for all providers.
• Update payor panels.
• Update insurance eligibility websites such as Availity and Trizetto.
• Assist with onboarding new hires with HR to ensure candidates have completed and submitted all required documents prior to onboarding.
• Ensures that provider medical licenses, board certifications, DEA and other pertinent information is renewed prior to expiration.
• Manages and maintains relationships with all payors to improve revenue.
• Performs all other contracting and maintenance needs required by payors.
• Experienced with MS Word and MS Excel, knowledge of HIPAA, ability to work independently and as a team.
• Able to multi-task, prioritize, and meet deadlines. Self motivated and able to stay on task.
• Working knowledge of healthcare insurance rules and guidelines.
• Understanding of RHC credentialing rules and guidelines.
• Must maintain regular and sustained attendance.
• Experienced with MS Word and MS Excel, knowledge of HIPAA, ability to work independently and as a team.
• Knowledge of office equipment to include fax, scanner, and copy machine.
• Excellent computer and data entry skills.

Schedule :

Education and Experience :

Equal Opportunity Statement :

QuickVisit is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment that is free of harassment, discrimination, or retaliation because of age (40 and older), race (including discrimination on the basis of a person's hair texture or protective hairstyle commonly or historically associated with race, such as braids, locks, and twists), color, national origin, ancestry, religion, creed, sex, sexual orientation (including transgender status, gender identity or expression), pregnancy (including childbirth, lactation, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics), marital status, AIDS / HIV status, veteran status, uniformed servicemember status, or any other status protected by federal, state, or local laws. The Company is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.

Requirements :