Credentialing/ Insurance Contracting Specialist

Job Description

The Credentialing and Insurance contracting Specialist is responsible for maintaining active status for providers and groups with Insurance plans by successfully completing initial and subsequent credentialing and contracting applications as required by commercial payers, Medicare and Medicaid in different states of USA.

Job Responsibilities

• Maintain individual provider files and group information to include up to date information needed to complete the required government and commercial payer credentialing applications.
• Maintain internal trackers to ensure all information is accurate and logins are available and legible.
• Update each providers CAQH database file timely according to the schedule published by CMS
• Complete revalidation requests issued by government 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
• Credential/ approve new and existing groups with government and commercial insurance plans.
• Coordinate with client and doctors and billing staff to identify and resolve any missing items, signatures, expiration of license or any other issues related to provider credentialing.
• Keep the clients updated on the progress of their application and scope of work.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Other duties as assigned

Knowledge, Skills and Abilities

• Knowledge of provider credentialing and contracting with government and commercial Insurance plans at least in one state in USA
• Minimum 1 year of experience in submitting applications for contracting and credentialing with Insurance plans.
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively