Credentialing Specialist

Summary

The Credentialing Specialist is responsible for coordinating, monitoring, and maintaining the external credentialing and re-credentialing processes for Clarity Clinic. The Credentialing Specialist will act as a liaison between the Credentialing Company and the Human Resources Department to coordinate the credentialing process. The Credentialing Specialist will assist in verifying professional training, certifications and licensing of healthcare professionals. The Credentialing Specialist will manage and maintain all license, DEA and COI renewals, ensuring that they are up to date and in compliance with state and federal regulations. The Credentialing specialist will also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.

Location: (Remote - Illinois) 

Compensation: $21/hr.- $28/hr. commensurate to years of experience. 

In this role, you will: 

• Assist in the processing of initial credentialing and re-credentialing applications by obtaining all providers’ new hire processing paperwork related to credentialing.
• Responsible for collecting all pertinent information from applicant and their malpractice insurer, and other relevant sources to assist in their credentialing applications.
• Obtain all provider licenses, current and renewed; Professional, DEA, Controlled Substance. Update each provider’s CAQH database file timely.
• Establish and maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain and track internal provider credentialing grid to ensure all information is accurate and logins are available, ensuring data is backed up.
• Maintain current and accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Complete revalidation requests issued by government payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete re-credentialing applications for commercial payers.
• Work closely with the Director of Reimbursement and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Monitor progress of credentialing status for all providers.
• Be the Liaison between providers and Credentialing Company and or insurance providers to ensure all needed documentation is provided and accurate for processing.
• Ensure databases detailing the practitioners’ education, training, licensing, experience and other information are up to date.
• Scan documents received from various departments.
• Locates documentation as needed by office staff.
• Identify discrepancies in information and conducting follow-ups.
• Capture primary source documentation in computer databases.
• Ensuring compliance with applicable laws, regulations, procedures, and policies.
• Maintain the strictest confidentiality according to the guidelines of company policies.
• Attend departmental meetings as required.
• Participate in development and training activities as required by management.
• Adapt to change in positive and professional manner.
• Any and all other duties as assigned.

Education and/or Experience

High school diploma or general education degree (GED); plus, a minimum of 2 years of physician credentialing experience. Must have working knowledge and understanding of medical insurance industry and managed care organizations.

Perks and Benefits:  

• Competitive compensation commensurate to years of experience.
• Full comprehensive benefits package including health, dental vision, EAP services and more. 
• $100.00 Monthly Wellness Reimbursement Stipend.
• 401k match up to 4%.
• 10 days (80 hours) of PTO + 5 Sick/Wellness Days and 6 Holidays. 

Apply today and join a team of dedicated professionals committed to transforming the lives of our clients. Make the work you do count! Join us in fighting the mental health care crisis in our world today, by providing the best support to our clinical team. Be the change! 

We celebrate diversity when it comes to all backgrounds and identities, and we encourage applications from minorities, LGBTQ+ individuals from nontraditional backgrounds. 

Please stay alert to protect yourself from sophisticated job scams during the recruiting process. Only emails that come from claritychi.com are legitimate recruiting messages. Our HR Team will not send emails from other domains, or message you using WhatsApp or text messaging. We conduct all interviews by phone or video, and we will never ask you for money or to download software either during the interview process, credentialing or during our onboarding process.

More tips from the FTC to avoid job scams: https://www.consumeraffairs.com/news/ftc-offers-tips-on-avoiding-job-scams-041321.html