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Credentialing Specialist

Lucid Lane

This is a Full-time position in Houston, TX posted August 31, 2021.

Provider Enrollment Credentialing Specialist – Lucid Lane Inc. MUST HAVE PROVIDER ENROLLMENT EXPERIENCE. Primary responsibilities include taking a new provider application from receipt to inclusion in payer directories and making ongoing updates. This involves accurate and timely entry of provider data, including provider applications and contract information, status changes, payee changes. It also includes verification of all the credentialing criteria for practitioners initial credentialing, re- credentialing, and following up with practitioners and payers as needed to obtain or supply information for the credentialing process and continued network participation with the payers. Job Duties and Responsibilities Enter and maintain provider applications, contracts, and updates into the practice/provider Credentialing files. Enter and maintain all provider information into credentialing database, spreadsheets and CAQH. Complete Medicare enrollments via internet PECOS and work with local MACs for provider enrollment issues Complete variety of state Medicaid enrollments for our clients throughout the US. Verify prospective and current providers license, liability insurance, CDS certificate, and DEA certificate, providers education, hospital privileges, board certification, malpractice coverage and other criteria as required. Verify accurate banking and billing information. Track payer contract applications status and provider participation levels, including recredentialing/revalidation requests. Update the credentialing database system to reflect approvals, denials, and/or terminations and insure all files have a welcome, denial, or term letter as appropriate. Meet required turnaround times and accuracy rates. Facilitate provider-related research based on suspended claims, Address returns, and other feedback opportunities. Assist with other duties as assigned. Required Skills Previous experience working with files or the collection and coordination of data (preferred). Knowledge of medical insurance carrier policies and procedures, and State and Federal rules and regulations Knowledge and expertise with Medicare (PECOS), various state Medicaid and Commercial payer provider enrollment processes Proficient in the use of Microsoft Excel, Word, and Adobe Acrobat (PDF). Ability to learn new software programs quickly. Excellent customer service skills including excellent verbal and written communication skills. Ability to maintain complete confidentiality in handling sensitive enrollment issues Professional and effective interaction skills with co-workers, clients, providers, and vendors. Proven ability to work well independently and as a team member. Ability to prioritize and organize multiple tasks and remain organized with multiple interruptions. Ability to research and understand various provider enrollment application formats, discover information requested and make decisions to complete the tasks required. Strong attention to detail. Ability to adapt to a constantly changing environment. Must have reliable internet connection and telephone Must have a good sense of humor and be able to accept and laugh at the shortcomings of the healthcare industry as a whole Job Type: Flexible hours; 40 hours per week Monday – Friday FULLY Remote Competitive Market Rate depending on experience and location Experience: Medical provider enrollment/credentialing: 2 years (Preferred) Medicare and Medicaid Guru Provider enrollment; 2 Years Required High school diploma or equivalent required; Associate s degree preferred. 2 5 years of experience in business environment-medical office experience preferred. Employment Type: Full Time Years Experience: 1 – 3 years Bonus/Commission: No
Associated topics: accounts receivable, authorization, bill, clinical documentation specialist, insurance, medical biller, medical billing, medical transcriptionist, review, transcription medical

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