Credentialing Specialist

Hunt Valley, MD
Jul 17, 2017
Aug 07, 2017
Accountant, IT
Full Time
Job Description The Credentialing Specialist plays a key role in professionally and courteously provide account follow-up through telephone calls, mail, email and other methods of communication. In this role, you will be responsible for Medicare, Medicaid, Managed Care, Blue Cross & Blue Shield, and commercial credentialing of all the SpecialtyCare physicians and IONM business lines. Hunt Valley, Maryland Duties and Responsibilities Locates and obtains credentialing applications from insurance carriers via website, telephone, contact or mail. Credential and re-credential all physicians in the practice with insurance providers. Completes applications in an accurate and timely manner according to established schedule. Obtains all necessary signatures and documentation to accompany applications. Follows up on status of the applications regularly to ensure receipt and proper handling by the insurance carriers. Maintains the CAQH file on each physician in the practice. Completes and accurately maintains a comprehensive provider database. Enrolls all physicians with current EDI vendor for claims submission and ERA. Completes applications for ACH payments. Addresses all issues regarding “remit to addresses”. Complete separate spreadsheet by payer and one by provider. Ensures practice addresses are current with health plans, agencies and other entities. Maintains confidentiality of provider information. Other duties and special projects as assigned. Qualifications 2 years related experience in physician credentialing. One year certificate from college or technical school or equivalent combination of education and experience. Solid computer skill in MS Office applications, especially Excel. Knowledge of Medicare, Medicaid, Blue Cross Blue Shield, commercial insurance, and managed care carriers. Knowledge of HIPAA regulations. Company Description Our Vision SpecialtyCare will be the premier provider of outsourced clinical services to hospitals and other healthcare providers by efficiently providing the best service, highest quality,and thoughtful innovation. Our Mission SpecialtyCare will provide superior value-added services by listening to and meeting the needs of our stakeholders. Our Values We know that its not enough for an organization to simply state its values. We are defined by our values and we strive to live them, every day. - Integrity - Sense of Urgency - Teamwork - Respect - Accountability - Continuous Improvement

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