C

CIVIE

Credentialing Specialist

Clerical & Data EntryConfirmed live in the last 24 hours
Full-timeRemote in USA$45k - $55k

About the Job

Requirements

  • A high school diploma or equivalent is required.
  • At least 2 years of relevant credentialing experience is required.
  • Working experience in CAQH, PECOS, Availity, and Verity is required.
  • Willingness to learn and build a process around onboarding new clients for payer claim enrollment and electronic funds transfer (EFT) enrollments is required.
  • The role requires attention to detail, the ability to manage multiple priorities and meet deadlines, comfort multitasking in a technology-driven environment, organization while navigating multiple systems, and discretion in handling sensitive and confidential information.

Responsibilities

  • Manage the full credentialing and re-credentialing process for assigned providers.
  • Conduct primary source verification of licenses, board certifications, education, training, and work history.
  • Submit and track credentialing applications to health plans, payers, and provider networks.
  • Maintain accurate provider records in credentialing databases and electronic systems.
  • Monitor expiration dates for licenses, Drug Enforcement Administration (DEA) registrations, malpractice insurance, and certifications to prevent lapses.
  • Ensure compliance with state, federal, and accreditation standards.
  • Review provider applications for completeness and accuracy, and follow up on missing or incomplete documentation.
  • Respond to payer inquiries and assist in resolving credentialing discrepancies or denials.
  • Communicate credentialing status updates to providers and internal stakeholders.
  • Identify opportunities to improve the efficiency, accuracy, and timeliness of credentialing processes.

Desired Qualifications

  • Certified Provider Credentialing Specialist (CPCS) certification is preferred.

About the Company

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