9 Credentialing Specialist Jobs in Baltimore, MD
Cynet Systems is Hiring a Credentialing Specialist Near Baltimore, MD
Pay Range $20hr - $25hr
Essential Function:
- 40% Analyzes credentialing applications to perform the primary source verification of the appropriate credentials in order for a practitioner to participate in the Client networks.
- Once verified, accepted and approved, determines the appropriate networks for participation and obtains the appropriate executed contracts to effectuate the professional relationship and structures the provider group accordingly.
- 30% Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status, credentialing, contractual status and provider file updates.
- Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved.
- Professional etiquette, communications and sound decision making is required.
- 15% Maintains the provider file, the Provider Information Control (PICS) inventory workflow system and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
- 10% Responsible for identifying, analyzing and resolving immediate and existing provider file issues.
- Processes provider file inputs in accordance with applicable state laws and departmental guidelines.
- Verification of provider data and system release entered into the provider file database, ensuring a successful integration with the other corporate systems.
- 5% Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.
- High School Diploma.
- 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or call center environment.
- Bachelor’s Degree in Business, Healthcare Administration or related field.
- Must be proficient in the use of Excel spreadsheets, and an understanding of Pivot tables., Proficient
- Excellent verbal and written communication and interpersonal skills.
- Ability to develop and maintain effective relationships with peers, physicians, and medical staff to create confidence, respect and dependability., Proficient
- Knowledge of medical terminology, Proficient.
- Demonstrated proficiency utilizing reference materials and ability to follow Standard Operating procedures to reduce risk and ensure provider data accuracy and overall quality., Proficient
- Ability to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and appropriate actions., Proficient
- Certified Provider Credentialing Specialist (CPCS) Pref.
Job Summary
Contractor
IT Outsourcing & Consulting
$44k-56k (estimate)
07/10/2024
01/04/2025
cynetsystems.com
ARCOLA, VA
500 - 1,000
2010
ASHWANI MAYUR
$50M - $200M
IT Outsourcing & Consulting
Related Companies
The job skills required for Credentialing Specialist include Customer Service, Managed Care, Written Communication, Communicates Effectively, Decision Making, etc. Having related job skills and expertise will give you an advantage when applying to be a Credentialing Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Credentialing Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Credentialing Specialist positions, which can be used as a reference in future career path planning. As a Credentialing Specialist, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing Specialist. You can explore the career advancement for a Credentialing Specialist below and select your interested title to get hiring information.
If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Credentialing Specialist job description and responsibilities
A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.
03/14/2022: Des Moines, IA
A credentialing specialist can have certificates that will prove useful to their field.
02/01/2022: Newark, NJ
Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.
02/21/2022: Evansville, IN
Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.
02/01/2022: Las Cruces, NM
Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.
01/18/2022: Pueblo, CO
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Credentialing Specialist jobs
Credentialing specialists can often find work with a high school diploma or the equivalent.
01/25/2022: Kingsport, TN
Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.
03/01/2022: Parkersburg, WV
While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.
12/25/2021: Little Rock, AR
Make Use Of Advanced Software For Monitoring.
01/18/2022: New London, CT
Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.
01/31/2022: Portsmouth, OH
Step 3: View the best colleges and universities for Credentialing Specialist.
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