Payor Credentialing Specialist (Dallas)

Payor Credentialing Specialist

The key responsibilities of the Payor Credentialing Specialist include but not limited to :

Duties and Responsibilities

• Prompt and regular attendance at an assigned work location.
• Ability to complete or oversee the completion of assigned tasks / projects in a timely manner.
• Complete process to enroll and credential facilities as well as providers with insurances; ensure all payor criteria are met.
• Leads, coordinates, and monitors the collection, review, and analysis of payor enrollment applications.
• Responsible for accuracy and completeness of payor enrollment submissions including supporting documentation.
• Follow up with providers and insurances for timely credentialing and enrollment process(es).
• Responsible for monitoring application progress and following up with payors as needed until confirmation of credentialing and network load is complete.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
• Review, and update if necessary; health plan directories, agencies, and other appropriate entities for current and accurate provider information
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and enrollment issues as they arise.
• Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.
• Enters and maintains accuracy of data input into Credential Stream, PECOS, NPPES, CAQH, Optum, Availity, and other payor portals.
• Verify provider accuracy in payor directories.
• Provide support with managed care delegated credentialing audits; conduct internal file audits.

Regulatory

Marketing and Outreach

Professional Development

Training

Minimum Requirements

Qualifications

In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below :

Physical Requirements and Working Conditions

The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity / expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.