We are seeking a dedicated and detail-oriented Credentialing Specialist to join our team. The ideal candidate will play a crucial role in ensuring that our healthcare providers are appropriately credentialed and compliant with all regulatory requirements.
Key Responsibilities:
Credentialing Process:
Manage the credentialing and re-credentialing process for healthcare providers, including physicians, nurses, and other medical staff.
Gather, verify, and maintain all necessary credentials, licenses, certifications, and insurance documentation.
Ensure compliance with industry standards, state and federal regulations, and accreditation requirements.
Provider Enrollment:
Complete applications for provider enrollment with insurance companies, Medicare, Medicaid, and other third-party payers.
Monitor the status of provider enrollments and address any issues or discrepancies.
Database Management:
Maintain accurate and up-to-date provider information in the credentialing database.
Conduct regular audits to ensure data integrity.
Communication:
Liaise with healthcare providers to obtain required documents and information.
Collaborate with internal teams, such as HR and billing, to facilitate the credentialing process.
Compliance:
Stay current on industry regulations and accreditation standards.
Ensure that the organization's credentialing processes meet all compliance requirements.
Reporting:
Generate reports on credentialing status, expirations, and compliance metrics for management.
Qualifications:
- Bachelor's degree in healthcare administration, business, or a related field (preferred).
- Previous experience in healthcare credentialing and provider enrollment specifically with an NEMT company is required.
- Knowledge of credentialing and enrollment software and databases.
- Familiarity with healthcare regulations, including Medicare and - Medicaid.
- Strong organizational skills and attention to detail.
- Excellent written and verbal communication skills.
- Ability to work both independently and collaboratively in a team environment.
-Preferably located in the Philippines
If you possess the skills we are looking for, we encourage you to apply and join our dynamic team. Please send us your updated resume, and we will promptly schedule an interview for you!
