Credentialing Specialist I

Job Duties

• Maintain organized and accurate files to ensure the credentialing is obtained from all physician and non-physician providers.
• Timely and appropriately apply for, process, submit, and maintain credentials and licensing with insurance companies and federally subsidized government plans, such as Medicare and Medicaid
• Ensure that all insurance companies have current and accurate information they need to process claims in a timely manner.
• Verify compliance of all documents prior to submission.
• Communicate effectively with clients on payer registration status and updates.
• Build and maintain relationships with payer representatives.
• Proactively identify and resolve any issues a client may face during the payer registration process.
• Demonstrate self-management behaviors and being a self-starter, following established policies and procedures and promote an efficient, cost-effective work environment.
• Keep RCM Account Managers, Supervisors and management, and providers informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, etc. to prevent delayed claims filing and cash flows.
• Sets up and maintains provider information in online credentialing databases and system
• Track license and certification expirations for all providers to ensure timely renewals

• 1-2 years of insurance credentialing experience including federal government plans
• Certified Provider Credentialing Specialist (CPCS) preferred
• Hands-on knowledge of the credentialing process
• Strong written and oral communications skills
• Working knowledge of Medical Terminology.
• May require some travel
• Experience working directly with providers
• Microsoft Office Suite
• Ability to work in a fast-paced environment

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.