Payer Credentialing Specialist

Job Description

Job Description

Nature & Scope : Positional Overview

Are you a meticulous problem-solver who thrives on keeping operations running smoothly behind the scenes? Join our client’s dynamic billing team as a Payer Credentialing Specialist and play a vital role in connecting healthcare providers with the coverage their patients depend on. In this essential position, you'll be preparing the correspondence, gathering credentialing paperwork, and working with the credentialing vendor to file with the insurance institutions for both initial and recertification. This includes coordinating with physicians, practice managers, practice directors, and executive-level leaders to ultimately guarantee no lapses of payer credentialing and to promote coordination with vendor and contracting teams; ensuring coverage and participation with insurance for patients and the community.

If you're ready to make a meaningful impact in a fast-paced healthcare environment, this is the opportunity for you.

Role & Responsibility :

Tasks That Will Lead To Your Success

• Works with other department managers and staff—including physicians, managed care, contracting, and other professional staff—to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with credentialing policies and procedures
• Provides oversight of verification and payer credentialing of health care professions and credentials are in compliance with state and federal standards
• Oversees process and organization of all-payer credentialing and re-credentialing paperwork with participating insurance companies
• Maintains a database of practitioner’s training, education, licensing, and experience information
• Key liaison with Medical Staff team, outside vendor, and IT for HIS system updates
• Assists in filling out, reviewing, and submitting applications with practitioners and other applicable staff
• Performs ongoing provider database maintenance for accuracy and completeness
• Remains compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), as well as state regulations—and relays this information to the necessary parties to ensure ongoing compliance organization-wide

Skills & Experience

Qualifications That Will Help You Thrive