What are the responsibilities and job description for the Credentialing Specialist position at Curis Functional Health?
Curis Functional Health, a rapidly expanding Dallas-based company featured in the Inc. 5000 and ranked among the top 50 in the DFW area, is seeking a highly organized and detail-oriented Credentialing Specialist to manage the credentialing process for our healthcare providers. The Credentialing Specialist will be responsible for ensuring the active status of all providers by successfully completing initial and ongoing credentialing packages as required by all insurance payers. The ideal candidate will have a thorough understanding of credentialing requirements and be adept at navigating various credentialing platforms and systems.
Responsibilities
- Maintain comprehensive and up-to-date individual provider files, including all information required for governmental and commercial payer credentialing applications
- Manage and update the internal provider grid to ensure the accuracy and availability of login information
- Timely update each provider's CAQH database file according to the CMS schedule
- Conduct bi-annual checks on the OIG Exclusion list for all providers, staff, and administrative personnel
- Apply for and renew provider licenses annually, including Professional, DEA, and Controlled Substance licenses within appropriate timelines
- Develop and implement provider onboarding credentialing procedures to ensure credentialing compliance and reduce revenue risks
- Complete revalidation requests from government payers
- Complete/facilitate the provider application screening process to ensure accuracy and eligibility
- Process initial and re-credentialing applications for new providers and re-credentialing applications for commercial payers, Medicare, and Medicaid
- Coordinate with hospitals to credential new providers and re-credential existing providers with staff privileges
- Collaborate with the Revenue Cycle Manager and billing staff to address any denials or authorization issues related to provider credentialing. Implement solutions to prevent future denials as necessary.
- Work closely with the Compliance and Risk Management Director to resolve OIG exclusions or other credentialing red flags
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Skills and Abilities
- Comprehensive understanding of provider credentialing and its direct impact on the practice's revenue cycle
- Ability to multi-task and maintain multiple databases/data tools (as necessary)
- Good communication and organizational skills
- Proficient computer skills, including Microsoft Excel, Word, and Internet usage
- Exceptional attention to detail and strong organizational abilities
- Effective planning and prioritization skills to meet deadlines
- Excellent customer service skills with clear and effective communication
Job Type: Full-time
Pay: From $20.00 per hour
Expected hours: 40 per week
Benefits:
- Health insurance
- Paid time off
Schedule:
- 8 hour shift
- Day shift
Work Location: In person
Salary : $20
