Credentialing Specialist

Chicago, IL
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Type: Direct-Hire

Category: Healthcare

Compensation Range: 55000.00 - 60000.00

Job ID: 183078

Date Posted: 12/01/2020


Nationwide, fast growing behavioral healthcare organization is looking for a
Credentialing and Contracts Specialist

Responsibilities:

•Prepare information necessary for contract renewals, amendments, licensing and certification applications, credentialing, and re-credentialing applications.

•Verify, update, and maintain records for multiple providers (Facility, Counselors, Nurses, & Physicians) to ensure that credentials are current so that providers can bill for professional services performed.

•Responsible for facilities credentialing and re-credentialing.

•Research contract compliance criteria and make recommendations.

•Assist with implementation of new contracts and programs.

•Prepare, gather, and distribute contract related documents for users throughout the organization

•Resolve basic concerns encountered with the credentialing process and escalate complex inquiries to the management.

•Create, implement, and monitor the tracking system for provider credentialing; provide assistance with the contracts management system.

•Conduct monthly internal audits on credentialing and re-credentialing files for accuracy and compliance with Credentialing Policies and Procedures to confirm all required verifications are complete and have been performed according to required standards and within required timeframes.

•Keep current regarding developments pertaining to contracting, both commercial insurance and government, and protected health information, applicable laws, and regulations, through reading of professional literature and attendance at appropriate seminars, conferences, and workshops.

•Other duties as assigned

Experience, Skills, Education and Abilities:

•Bachelor’s degree preferred (some college a must)

•3+ years of physician and facility credentialing experience, including experience with system provider contract system configuration and contract interpretation

•Strong knowledge of credentialing; Medicaid & Medicare experience

•Ability to communicate with others to gather and exchange information

•Ability to respond to telephone inquiries

•Ability to continually proofread, check and verify contracts and data

Benefits and Perks:

Excellent Benefits, 18 PTO Days, Tuition Reimbursement, and Room for Advancement

 


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