What are the responsibilities and job description for the Healthcare Credentialing Specialist position at Pinnacle Wound Management?
About Us:
Pinnacle Wound Management is a national leader in providing specialized wound care services to nursing home residents across the country. Our team of dedicated wound care specialists delivers weekly care to improve patient outcomes and quality of life. We are seeking an experienced and detail-oriented Healthcare Credentialing Specialist to join our growing team.
Job Summary:
The Healthcare Credentialing Specialist will play a crucial role in ensuring our providers and facilities maintain active status across multiple states. This includes managing initial and ongoing credentialing processes, maintaining provider profiles, and ensuring compliance with governmental and commercial payer requirements.
Key Responsibilities:
- Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirements.
- Complete and track initial and recredentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care Organizations.
- Assist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbers.
- Monitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelines.
- Manage termination of payer enrollments for providers leaving the organization.
- Provide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entities.
- Collaborate with the Director of Operations to ensure timely credentialing and recredentialing of all providers.
- Track and ensure the renewal of state DEA licenses, board certifications, and malpractice insurance.
- Identify and resolve potential onboarding issues, offering solutions to streamline the credentialing process.
- Maintain records of all managed care contracts and ensure portal logins remain active.
- Ensure compliance with relevant accrediting and regulatory agencies.
- Monitor trends and recommend improvements to credentialing workflows.
Qualifications:
- Education:
- Minimum: High School Diploma or equivalent with 5 years of experience in healthcare administration and credentialing.
- Preferred: Associate degree with at least 2 years of relevant experience.
- Experience:
- Minimum of 2 years of experience in healthcare credentialing, including provider enrollment through PECOS, NPPES, CAQH, and Managed Care Organization portals.
- Experience tracking license and certification expirations.
- Direct experience with payer credentialing and provider enrollment (required).
- Skills and Abilities:
- Strong interpersonal and communication skills.
- Excellent organizational abilities and attention to detail.
- Proficiency in Microsoft Office, internet applications, and electronic health record (EHR) systems.
- Ability to work independently and manage multiple tasks simultaneously.
- Behavioral health knowledge (a plus).
Why Join Us?
At Pinnacle Wound Management, you’ll be part of a mission-driven team dedicated to improving patient care. We offer a collaborative work environment and opportunities for professional growth. If you’re passionate about healthcare administration and have the expertise to streamline credentialing processes, we encourage you to apply.
Job Type: Full-time
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Application Question(s):
- Do you have experience using CAQH?
- Do you have experience using PECOS?
- Do you have experience enrolling providers with different state Medicare Contractors?
Experience:
- provider enrollment and health care: 2 years (Required)
- EDI and ERA set up: 2 years (Preferred)
Work Location: In person
