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- Credentialing Specialist
- W2 Contract-to-Hire, 6 Months
- Location: Remote
- Training: First week not to exceed 2 in person onsite training days per week in Columbia.
- Analyzes and researches credentialing applications/provider contracts to verify that appropriate information has been obtained as well as handles incoming and outgoing correspondence regarding the applications. Determines the appropriate networks for participation and obtains the appropriate executed contracts. Maintains the on-line provider file and hard copy file with updated provider information- Credentials and re-credentials providers to appropriate levels. Maintains the Application Log in accordance with state legislation. (35%)
- Assign provider numbers and updates demographic information on the corporate database for publishing provider information in our various directories. Processes applications and updates in accordance with applicable state laws and guidelines. Maintains database for all provider information updates to support corporate mainframe system for all network provider or subscriber inquiries and is fundamental in supporting the provider special pricing process. (30%)
- The incumbent addresses questions involving professional entities and contractual questions. Determines the nature of inquiry, researches available information and determines the proper actions required. Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status and provider file updates. (20%)
- Prepares written responses in order to obtain incomplete or missing information. Mails appropriate provider packet when required. Mails confirmation letter to professional providers identifying necessary provider numbers for proper billing. (10%)
- This position has no supervisory responsibility
- High school diploma with 2 years of college or commensurate work experience.
- 6 months - 1 year direct experience with provider contracting, credentialing or network management.
- Credentialing Specialist experience
- Credentialing or Provider file maintenance experience.
- Knowledge in Microsoft Office and Excel required.
- Be able to attach PDFs from email transactions
- Familiarity with PC, mainframe applications and working in multiple systems.
- Data entry experience with the analytical skills to research and analyze data.
- Demonstrated success in handling large volumes of work.
- Ability to organize, prioritize, and accomplish tasks within established timeframes.
- Strong service skills and possess ability to remain calm in stressful situations with medical professionals.
- Effective verbal and written communication skills.
- Able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
- Must have their own laptop/desktop with high speed internet and a workspace to focus to succeed in the role.
- 3-5 years direct experience with provider contracting, credentialing or network management.
- Medical/Healthcare terminology and Certified Provider Credentialing Specialist.