Payer Credentialing Specialist

Murray, Kentucky, United States Full-time

The Provider Credentialing Specialist is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of credentialing and re-credentialing individual Providers with payers. Continuous follow up on the status of applications for Providers and meticulous tracking of said status is crucial to the effectiveness of this position. The Provider Credentialing Specialist also maintains a strict level of confidentiality for all matters pertaining to Provider credentials.

Essential Job Responsibilities:

  • Maintains individual Provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
  • Completes credentialing applications to add Providers to commercial payers, Medicare, and Medicaid
  • Maintains internal Provider grid to ensure all information is accurate and logins are available
  • Applies for and renews annually all necessary Provider licenses for each individual Provider
  • Completes revalidation requests issued by government payers and completes re-credentialing applications for commercial payers
  • Responsible for working claim issues related to payer credentialing issues and works closely with claim denial team for quick resolutions to meet specified guidelines of individual payers
    • Works closely with the Director of Revenue Cycle, Assistant Director of Business Office, and other billing staff to identify and resolve denials or authorization issues related to Provider payer credentialing • Maintains accurate Provider profiles on CAQH, PECOS, NPPES, and CMS databases
  • Updates each Provider’s CAQH database file timely according to the schedule published by CMS
  • Reviews new Provider packet information to determine and address any credentialing issues
  • Works closely with Provider Liaison & Recruiter to obtain missing documentation pertaining to payer credentialing.
  • Obtains required client signatures and follows up with the carriers on documentation submitted.
    • Responds to internal and external inquiries on routine enrollment and contract matters.
  • Monitors and advises payers on license expirations.
  • Provides routine follow-up and status confirmation of Provider credentialing applications.
  • Maintains effective communication & professional interaction with payers and Providers.
  • Effectively utilizes and navigates governmental & non-governmental websites.
  • Independently researches and resolves Provider credentialing application questions.
  • Other duties as assigned


Requirements:

  • Excellent computer skills including Excel, Word, Internet; possess ability to quickly learn and operate hospital database systems
  • Detail oriented with exemplary organizational skills
  • Plans and prioritizes to consistently meet deadlines
  • Excellent customer service skills
  • Effective interpersonal skills and communication skills both written and verbal
  • Strong analytical and problem solving skills
  • Medicare, Medicaid, and Commercial Payer Provider credentialing knowledge

• Build and maintain results-driven working relationship with team members, Providers, and payer contacts