Credentialing Specialist Job at South Heart Clinic, Harlingen, TX

cUpPSTZZVWRONzg0NFIrQlRKZVd0UHdGMXc9PQ==
  • 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,

Similar Jobs

USA DeBusk, LLC

Vacuum Truck Operator Job at USA DeBusk, LLC

 ...Vacuum Truck Operator - Class A & B CDL Classification: Non-Exempt (Hourly) Department: Industrial Services Division Reports to: Branch Manager Company Profile: USA DeBusk is a best-in-class mechanical and industrial cleaning services provider specializing... 

Quality Correctional Care

RN or LPN Part Time & PRN Job at Quality Correctional Care

 ...Location: Tippecanoe Community Corrections Shift Opening(s): 7AM to 7P M for one shift a week Requirements: Valid LPN or RN licensure Valid CPR certification Must be able to stand for extended periods of time Must be able to push, pull, reach, and... 

The Bergaila Companies

Measurement Field Engineer Job at The Bergaila Companies

 ...required; technical drafting or CAD certification preferred Responsibilities: Draft new Site Facility Diagrams (SFDs) for oilfield measurement sites using Muddy Boots Online (MBO) software Review and correct existing SFDs to reflect current facility... 

Pride Health

Occupational Therapist Job at Pride Health

 ...Job Summary We are seeking a skilled Occupational Therapist to provide inpatient care in a hospital-based setting. The ideal candidate will...  ...Qualifications Active New Jersey Occupational Therapist (OT) License Graduate of an accredited Occupational Therapy program... 

Icon Sports Group

Amazon Vendor Central ads assistant Job at Icon Sports Group

 ...Key Responsibilities: Manage and maintain product listings and ads on Amazon Vendor and Seller Central and Walmart platforms. Create new product listings by generating product information and utilizing bulk feeds on Vendor Central, Seller Central, Walmart, and Shopify...