Ascendo Resources is actively seeking a Credentialing Specialist to join the team of our client in the healthcare field. This position would be under the direct supervision of the Director of Revenue Cycle Management, the Part-time Revenue Cycle Specialist (Credentialing and Billing) will assist in maintaining active status for all providers and facilities by completing initial and subsequent credentialing packages as required for Article 31, Article 32, CORE/HCBS, CMS Medicare, Medicaid, commercial plans and Managed Care Organizations.

This includes maintaining individual providers' and facilities' updated profiles in various health insurance portals, CAQH, PECOS, NPPES, Navinet, Availity, PlaySpan, CMS databases, commercial plans, and Managed Care Organizations ‘portals. Assist new individual providers in completing applications for National Provider Identifier (NPI).

The individual assists in performing critical billing functions to maximize revenue collections, including but not limited to eligibility verification, denial management, payment posting, adjustments, and allocation. There are 20-30 licensed provider that need to be credentialed (doctors, nurse, mental health counselors, LCSW).

Job Title: Credentialing Specialist

Pay Rate: $23/hr - $25/hr

Schedule: (Mon - Fri , 9am - 5pm)

Key Responsibilities:

• Maintain individual provider files and update information for governmental and commercial payer credentialing applications.
• Ensure the accuracy of providers' information and availability of logins.
• Manage tracking logs for Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH portals.
• Ensure timely renewal of individual providers' licenses and update CAQH database files as scheduled.
• Complete credentialing and re-credentialing applications for providers to commercial payers, Medicare, and Medicaid.
• Assist new providers with National Provider Identifier (NPI) applications.
• Terminate enrollments with payers upon provider resignation or termination.
• Provide updated demographic information and supporting documents to external participants.
• Collaborate with the behavioral health programs' director and assistant directors to ensure timely credentialing.
• Work with the Director of Revenue Cycle Management and billing staff to resolve credentialing-related denials or authorization issues.

Qualifications:

• High school diploma or equivalent; Associate degree strongly preferred
• 2 years’ experience in healthcare administration, credentialing individual providers and facilities.