Credentialing Specialist
Job Summary
The Credentialing Specialist (CS) supports our pediatric practice clients by managing the enrollment of new providers with payors. In this role, you will serve as a vital internal resource for our billing team, addressing all credentialing-related matters to ensure seamless operations and reimbursement.
We hire for both remote and onsite positions.
Qualifications
- Experience: At least 4 years of combined experience in healthcare administration, including billing, compliance, or credentialing. A minimum of 2 years must be specifically focused on credentialing or payor enrollment.
- Industry Knowledge: Deep understanding of medical provider credentialing principles, accreditation policies, and documentation procedures.
- Research Skills: Demonstrated ability to research and stay updated on specific requirements for various payors.
- Technical Proficiency: Strong comfort with technology, including proficiency in Google Workspace (Gmail, Drive, Docs, Sheets).
- Soft Skills: High attention to detail, strong organizational skills, and the ability to manage time-sensitive projects independently.
- Judgment: Ability to use independent judgment while managing and communicating confidential information securely.
Responsibilities
- Manage payor enrollment for new providers for both new and established clients.
- Maintain credentialing for existing clients and handle enrollment for new hires within the practice.
- Ensure that each provider’s CAQH profile is complete and accurate.
- Actively communicate with practice managers and stakeholders regarding the status of the credentialing and enrollment process.
- Foster professional relationships with payors or IPAs to ensure credentialing is completed within a timely manner.
- Create and maintain an internal provider database to track re-enrollment and ensure all information stays current.
- Address questions regarding contracts and credentialing as they relate to billing and reimbursement.
- Manage demographic updates, such as new practice locations.
- Stay current with industry changes and provide necessary communication and training to Account Managers.
- Collaborate closely with Account Managers and the billing team to resolve credentialing-related denials.
Additional Qualifications for Any Remote Work
The position is available fully remote for candidates who live beyond a reasonable commuting distance from our office in Winooski, VT. Local Vermont candidates are invited to apply for a hybrid position (3 days in office, 2 days remote).
- A private, dedicated space to ensure HIPAA compliance
- Sufficiently high speed and reliable internet service to perform the job. Download speed: optimal 10-20 mbps. Upload speed: over 5 mbps. Latency: under 50 is ideal. (Anything above 100 ms will not work.) A speed test for these metrics is available at https://speedof.me/
Benefits
- Health, vision, dental insurance, and short-term disability
- CTO accrued from the 1st day of employment, beginning with 2 weeks
- 6 paid holidays with 5 additional paid days
- 3 paid days for personal emergency
- Paid time off for volunteer community service
- Paid parental leave
- Employee retirement account with 3% matching
- Employee Assistance Program
PedsOne is an E-Verify employer