Demo

Credentialing Specialist

Azalea Health Innovations Inc
Atlanta, GA Full Time
POSTED ON 2/1/2025
AVAILABLE BEFORE 5/2/2025

Job Description

Job Description

IN SUMMARY...

The Credentialing Specialist is responsible for credentialing and recredentialing providers contracted with the company. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Credentialing functions include, but are not limited to, processing credentialing applications, updating and maintaining credentialing database in accordance with internal policies and procedures, CAQH maintenance, and complying with applicable state and federal requirements

WHAT YOU WILL DO...

  • Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the payor application process.
  • Efficiently perform all aspects of initial credentialing and recredentialing process to ensure current credentials and timely handoff and / or review and approval of practitioner files.
  • Respond to all practitioner, client health plan and internal inquiries within 1 business day.
  • Maintain electronic data files for CAQH to submit practitioner data, as required.
  • Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s).
  • Collaborate with participating clients, department manager and / or external agencies to facilitate and ensure smooth hand-off from enrollment completion to billing.
  • Submit tasks for invoicing.
  • Use critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
  • Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
  • Keep Manager informed of potential credentialing or enrollment issues.
  • Perform duties in a timely manner as required by clients and company.
  • Azalea advocate at all times.
  • Other duties, as assigned.

BACKGROUND AND SKILLS YOU WILL BRING...

  • High School diploma or GED
  • Experience should include responsibility for medical and professional credentialing processes, policies and procedures and delegated credentialing requirements
  • Must have strong organizational skills
  • Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up
  • Capable and comfortable dealing with sensitive and confidential information with discretion and trust
  • Strong oral and written communication skills
  • Problem solving and analytical skills
  • Computer data entry
  • Proficiency with MS Office Suite
  • Ability to follow instruction and adhere to company policies and procedures
  • Must be a team player and willing to learn and take on new responsibilities
  • Ability to represent the company in a professional manner at all times
  • SUCCESS LOOKS LIKE...

  • Being aggressive and taking initiative; we trust you to move the needle forward
  • Doing the job; outcomes are just as important as strategy
  • Being adaptable and amenable to meet the changes of a dynamic and evolving industry
  • Demonstrating humility; partnership and collaboration is who we are and how we operate
  • Tapping into your innovative side; conventional is not always correct
  • HOW WE INVEST IN YOU...

  • Competitive and comprehensive benefits : Coverage options to support the whole person, including full medical, dental, vision, and life insurance
  • Generous employer sponsored subsidy towards employee's medical insurance premiums

  • Azalea Health covers 100% of the premiums for Life AD&D and Long-Term Disability for all eligible full-time employees
  • Balance and flexibility : Simple Paid Time Off (PTO) options. You earn your time, use it as you choose.
  • Economic opportunity : Competitive total rewards package that offers competitive pay and advancement opportunities
  • Azalea Health's EEO Statement

    Azalea Health is an Equal Opportunity Employer committed to creating a diverse and inclusive workforce where our employees excel based on merit, qualifications, knowledge, ability, and job performance. We embrace and encourage our employees' differences in age, color, disability, ethnicity, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socioeconomic status, veteran status, and any other characteristics protected by federal, state, and local laws that make our employees unique.

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