Credentialing Specialist

Overview:

We are seeking a detail-oriented and organized Credentialing Specialist to join our team, an established ENT (Ear, Nose, and Throat) practice. The Credentialing Specialist will play a key role in ensuring that our healthcare providers are properly credentialed and compliant with all necessary regulatory standards. This position requires excellent attention to detail, strong organizational skills, and an understanding of medical insurance, healthcare regulations, and credentialing processes.

Key Responsibilities:

• Credentialing and Recredentialing:

  • Obtain, verify, and maintain up-to-date credentials for all healthcare providers (physicians, nurse practitioners, etc.) within the practice.
  • Manage the recredentialing process to ensure timely submission of required documentation and adherence to regulatory timelines.
  • Review and process applications for insurance panels and networks, ensuring compliance with all payer requirements.

• Maintain Accurate Records:

  • Ensure all credentialing documentation, licenses, certifications, and background checks are filed and stored securely.
  • Track expiration dates for medical licenses, malpractice insurance, board certifications, and other required documentation.
  • Keep accurate, up-to-date files for each provider, ensuring proper documentation is available during audits.

• Insurance Contracting:

  • Communicate with insurance companies to verify credentialing status and resolve any issues related to provider participation.
  • Assist with negotiations for new insurance contracts and provider enrollments.

• Compliance:

  • Stay up-to-date with local, state, and federal regulations governing medical practice credentialing and ensure practice compliance.
  • Ensure that providers are compliant with healthcare regulations and that they meet all necessary qualifications for the insurance companies with which the practice contracts.

• Reporting:

  • Prepare reports on credentialing status, recredentialing timelines, and any potential issues for management.
  • Work closely with other departments, including billing and HR, to ensure smooth operations and compliance.

Qualifications:

• Education:

  • High school diploma or equivalent required; Associate's or Bachelor’s degree in healthcare administration, business, or related field preferred.

Equal Opportunity Employer:

Our practice is an equal opportunity employer and is committed to fostering a diverse and inclusive workplace. We welcome applicants from all backgrounds and identities to apply for this position.

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