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Job Title: Credentialing Subject Matter Expert

Location: Dallas TX

Position Type: Immediate hire for a fulltime / Contract position

Responsibilities

  • 5 years of experience in provider contracting and credentialing for multiple specialties.
  • Experience in both group and individual provider credentialing.
  • Expertise in state and payer specific guidelines/ Updates.
  • Experience in credentialing of Major payers such as Medicare, Medicaid, Tricare, BCBS, Optum, Aetna, Signa, Humana and other commercials and replacement payers.
  • Should be well versed in creating CAQH profile ( Council for Affordable Quality Healthcare), NPI for the practices (National Provider Identifier), creating PECOS profile (Provider, Enrollment & Ownership System).
  • Experience in Delegated Credentialing.
  • Strong verbal and written communication skills.

Role

  • Reviews and prepares payer credentialing applications and recredential application for completeness and accuracy.
  • Works with providers and Insurance credentialing department to ensure required information is submitted to complete the process.
  • Candidate will be responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process.
  • Build and manage a tracker to provide daily, weekly and monthly credentialing status report.
  • Review credentialing files and work with healthcare providers to obtain missing, incomplete and expiring items and CAQH Maintenance activity.
  • Filling and submitting the credentialing applications forms to payers.
  • Work with billing department to address non-participation or dis-enrolled providers.
  • Prepare reports for internal and external use.

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