Job Description

Terms of Employment

• Contract, 6 Months (Likely Extension / Possible Conversion)
• This position is primarily remote. With that said, candidates must reside a commutable distance to Baltimore, MD (DC, Maryland, Virginia) to consider onsite work (trainings, team meetings, collaboration sessions, etc.) roughly once every three or four months.

Overview

Our client is looking for a Credentialing Specialists to join the team to help support the credentialing of the new practitioners for network participation within the organization’s Behavioral Health Network. The Specialists must verify that the provider can participate in the program and accurately maintain all provider data within the enterprise-wide Provider file according to Industry Standards. This role is highly data-driven and requires meticulous attention to detail, particularly in managing and reconciling data in Excel. The ideal candidate will combine their credentialing experience with advanced Excel skills to ensure the accuracy and efficiency of the credentialing process.

Responsibilities

• Receive provider applications that they will work on from start to finish. There are twelve (12) primary source verification to complete in the credentialing file, once completed, they will take this data and enter it into the EVIP system. After the data is added to the EVIP system they will be required to complete a spreadsheet that is added to the downstream systems to claims department for approval ensuring a successful integration with the other corporate systems (most verifications are completed within 30 days, due to certain documents that may expire).
• 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.
• Maintains the provider file, the Provider Information and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
• 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.
• Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.

Required Skills & Experience

• 2+ years of credentialing experience in the healthcare / health insurance industry.
• Experience doing primary sourcing of credentials (licenses, work experiences, etc.).
• Experience using Pivot Tables and VLOOKUPs in Microsoft Excel.
• Experience in delegated provider credentialing.
• Highly skilled in Microsoft Office – namely Microsoft Excel.
• General clerical / data entry skills.
• Excellent written (emailing) and verbal (phone etiquette) communication skills.
• Strong customer service skills.
• Highly organized and detail oriented.
• Able to quickly learn new systems and navigate multiple portals simultaneously.

Preferred Skills & Experience

• Experience using MD-STAFF or similar provider credentialing database.

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