CREDENTIALING SPECIALIST

TITLE: CREDENTIALING AND PAYOR ENROLLMENT SPECIALIST

POSITION TYPE: FULL TIME

REPORTS TO: OPERATIONS MANAGER

FLSA CATEGORY: NON-EXEMPT

DEPARTMENT: ADMINISTRATION

MAIN LOCATION: 3676 PARKER BLVD, PUEBLO, CO 81008

JOB SUMMARY: This position is required to perform all duties of the Credentialing and Payor Enrollment Specialist. This position will be responsible for credentialing individual, facility, and/or ancillary medical providers to ensure all initial credentialing, subsequent credentialing, and internal requirements are met and maintained as required with licensing board, hospitals, certification agencies, training programs and medical groups, practitioners, commercial payers, Medicare, and Medicaid. The Credentialing and Payor Enrollment Specialist also maintains excellent relations and liaison between payers, clinics, and providers to assist in ensuring participation status is managed in a timely and accurate manner.

*** THIS IS NOT A REMOTE POSITION. THE EXPECTATION WILL BE 5-DAYS PER WEEK IN PERSON ***

DUTIES AND RESPONSIBILITIES

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain internal provider grid to ensure all information is accurate and logins are available.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Update each provider’s CAQH database file timely according to the schedule published by CMS.
• Apply for and renew annually all provider licenses; Professional, DEA, and Controlled Substance.
• Complete revalidation requests issued by government payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete re-credentialing applications for commercial payers.
• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
• Work closely with the Business Office Manager and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain work area in a clean, sanitized, and organized manner.
• Follows all Infection Prevention policies and procedures.
• Attends annual required company programs and trainings.
• Attends all regular required department and company meetings.
• Maintains strictest confidentiality.
• Performs all other tasks and projects assigned.