Demo

Credentialing Provider Specialist

Cynet Systems
Baltimore, MD Contractor
POSTED ON 2/6/2025
AVAILABLE BEFORE 4/2/2025
Job Description:

Pay Range: $20hr - $25hr

Essential Functions:
  • 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.
  • Reconciling delegated rosters, creating delegated provider profile configurations request for loading information into data system.
  • 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, database 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.
Education Level:
  • High School Diploma.
Experience:
  • 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or call center environment.
Preferred Qualifications:
  • Bachelor’s Degree in Business, Healthcare Administration or related field.
Knowledge, Skills and Abilities:
  • Must be proficient in the use of Excel spreadsheets, and an understanding of Pivot tables.
  • 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.
  • Knowledge of medical terminology.
  • Demonstrated proficiency utilizing reference materials and ability to follow Standard Operating procedures to reduce risk and ensure provider data accuracy and overall quality.
  • Ability to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions.
Licenses/Certifications:
  • Certified Provider Credentialing Specialist (CPCS) Preferred.

Salary : $20 - $25

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