Job Description

Job Title: Credentialing Specialist

Department: Credentialing and Enrollment

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JobPurpose and Position Overview:

Team Leader responsible for the performance, productivity and effective management of team members of Credentialing. He would ensure that the providers of a group are properly licensed and certified as mandated by state and federal regulations to credential & contract them with insurance carriers. The Team Leader would report to Asst. manager & is responsible to maintain smooth client relationship.

Specific Job Duties &Responsibilities:

1. List key Duties & Responsibilities

1.  Completion and submission of provider
   

enrollment applications to payers

2.  Update mailing/physical address.
   

3.  Registration of payers’ provider web portal
   

access.

4.  Maintenance of documentation and reports
   

regarding provider enrollments in process.

5.  Retain records related to completed provider
   

enrollments

6.  Maintain provider enrollment information
   

within the credentialing database.

7.  Interact with plan representatives by phone or
   

email to provide appropriate and timely response to inquiries and concerns regarding provider.

8.  Respond to client inquiries regarding status
   

of applications received.

9.  Proactive follow up with insurance plans to
   

monitor status of provider applications.

1. Resolve enrollment application deficiencies.

2. List of general Duties/Responsibilities

1.  Maintain strict confidentiality of information
   

as per current HIPAA requirements.

2.  Collaborate with leadership and teammates on
   

process improvement.

3.  Get tasks done by using all of the resources
   

available.

4.  Actively Participate in client and team meetings.
   

5.  Manage credentialing work orders, tickets to
   

ensure all established time frames for completing work and projects are met.

6.  Monitor provider credentials and communicate
   

to managers to ensure providers remain up to date with state and/or federal regulations

7.  Audit new staff’s work and give feedbacks.****
   

3. DailyRoutine:

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1.  Complete work orders assigned
   

through tickets and emails.

2.  Follow up with the Payers to
   

obtain the status of credentialing application.

3.  Work on pending/in process service
   

tickets & project tickets.

4. Weekly routine:

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1.  Credentialing meeting with team.
   

5. Quarterly Routine:

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1.  Completion of Rocks
   

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6. Qualifications:

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1.  Any Degree
   

2.  Should have minimum 4+ years of
   

experience in Medical billing.

3.  Should have worked in various
   

specialties and be a motivational mentor.

4.  Good written and verbal communication skills.
   

5.  Good Typing skills.
   

6.  Regular attendance.
   

7. Measuresof Performance:

1.   Performance measured by productivity &
   

Quality.

8. Supervisory Responsibilities:

1.   Audit new staff’s work and give feedbacks.
   

9. Training Requirements:

1.   Credentialing Activities