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.
