Credentialing Specialist

Warrensville Heights, OH

Post Date: 11/10/2017 Job ID: 481661 Industry: Clerical

- Credentialing Specialist/Provider Reg. person
-Need to be familiar with CAQH, applications and so forth.
-At least 2 -3 years exp.
-starting pay $16.00/hour.


Strong knowledge and understanding of the credentialing process.
Ability to work in fast paced environment. maintain effective working relationships with providers, management, colleagues, and contacts outside of the organization.

-Must be computer literate to complete tasks as required.; ability to retrieve emails, complete on line enrollment for health insurance benefits and any other programs as assigned.
-Good communication skills, both verbal and written, with ability to work with all levels of personnel
-Good understanding of structured development methodologies and project control techniques
-Must be self-starter
-Detail and Goal oriented and able to work as part of a team
-Ability to learn and suggest different techniques
-Good problem solving and organizational skills and abilities
-Mathematically inclined


-Enroll the practices and providers with insurance companies. Includes initial applications, re-credentialing applications and any applicable follow up on provider status.
-Collect, update, and maintain necessary provider information and documentation and verify the information.
-Maintain copies of current state licenses, DEA certificates, malpractice coverage, pharmacy licenses, -CLIA waiver, and any other required credentialing documents for all providers.
-Maintains corporate provider contract files, fee schedules, and contract addendums. Monitors any changes and notifies supervisor.
-Verify provider and group information with insurance companies. Audits health plan directories for current and accurate provider information.
-Complete and maintain CAQH, NPI, and PECOS accounts.
-Maintains provider profiles within System.
-Communicate any applicable address updates, provider or practice changes to insurance companies. 9. -Provide concise, timely communication to supervisor regarding potential credentialing issues.
-Maintain electronic credentialing files with provider information.
-Track information regarding provider status with insurance companies that will include effective dates and provider numbers.
-Completes any and all other duties as assigned.
-Responsible for checking emails and on line learning assignments (Swank) on a regular basis.

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