Medical Credentialing Specialist (WFH)

Key Responsibilities:

Compiles and maintains current and accurate data for all providers.

  •  Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Maintains corporate provider contract files.3
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Sets up and maintains provider information in online credentialing databases and system.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Tracks license, DEA and professional liability expirations for healthcare providers
  • Maintains appointment files, and information in credentialing database.
  • Audits health plan directories for current and accurate provider information.


ADDITIONAL RESPONSIBILITIES:

Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.

  • Provides credentialing and privileging verifications.
  • Performs other duties as assigned.


Key competences:

Knowledge and understanding of provider credentialing and its direct impact on the practice’s revenue cycle

  • Excellent verbal and written communication skills including, letters, memos and emails.
  • Excellent attention to detail.


Experience:

  • With at least 1-2 years of customer service or administrative experience preferably in a high-volume call centre, or customer focused administrative position.
  • 2 years’ experience credentialing experience preferred

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