Job description

USA Clinics Group is growing and seeking a motivated Credentialing Specialist to join our team! The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by Medicare and Medicaid, commercial payers, hospitals, and regulatory agencies.

This position is flexible to be hybrid. Must work 2-3 days per week in the Northbrook, IL office.

Responsibilities

Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
Maintain internal provider grid to ensure all information is accurate and logins are available
Update each provider’s CAQH database file timely according to the schedule published by CMS
Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
Complete re-validation requests issued by government and commercial payers
Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
Complete re-credentialing applications for commercial payers
Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
Work closely with the Billing and Authorizations Departments to identify and resolve any denials or authorization issues related to provider credentialing
Maintain accurate provider profiles on ECHO, CAQH, PECOS, NPPES, and CMS databases
Other duties as assigned

Requirements

1 year of prior credentialing experience in a non-hospital setting, required
Associates Degree, required, Bachelors Degree, preferred
Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
Detail oriented with above average organizational skills
Excellent customer service skills; communicates clearly and effectively
Pay Rate: $24.00-$30.00

This position is flexible to be hybrid. Must work 2-3 days per week in the Northbrook, IL office.

Benefits