Credentialing Specialist

About Five Talent Accrete: Five Talent Accrete is a leading healthcare solutions provider committed to delivering excellence in medical coding, revenue cycle management, and healthcare consulting. We are dedicated to fostering a collaborative and innovative work environment that empowers our employees to contribute to the success of our clients.

Position Description: We are seeking a highly skilled and motivated individual to join our healthcare organization as a Medical Credentialing Specialist with a strong background in project management. In this crucial role, you will be responsible for overseeing the credentialing process for healthcare providers, ensuring compliance with industry standards, and optimizing workflow through effective project management strategies.

Position Duties: 

1. Credentialing & Re-Credentialing

• Verify healthcare providers education, training, licensure, certifications, and work history.
• Ensure compliance with state, federal, and accreditation standards (e.g., NCQA, CMS).
• Process initial credentialing and re-credentialing applications for providers and facilities.
• Coordinate with insurance payers and hospitals for provider enrollment.

2. Provider Enrollment & Compliance

• Complete and submit applications for Medicare, Medicaid, and commercial insurance enrollments.
• Monitor and track provider licenses, DEA registrations, and other certifications to ensure timely renewals.
• Stay updated on state and federal regulations related to provider credentialing.
• Resolve discrepancies or delays in the credentialing and enrollment process.

3. Documentation & Record Keeping

• Maintain accurate and up-to-date credentialing files for each provider.
• Utilize credentialing software and databases to track provider status.
• Ensure all documentation meets legal and regulatory requirements.
• Generate reports related to provider credentialing, expirations, and enrollment status.
• Prepare for internal and external audits related to credentialing and provider enrollment.
  

4. Communication & Coordination

• Act as a liaison between providers, insurance networks, healthcare facilities, and regulatory agencies.
• Work closely with HR, medical staff offices, and billing departments.
• Notify providers of any missing or expired credentials and assist in resolving issues.

5. Reporting & Audits

• Generate reports related to credentialing status and compliance.
• Prepare for internal and external audits related to credentialing and enrollment.
• Identify and resolve any credentialing discrepancies or delays.

Position Requirements:

1. Education and Certification:

• Bachelor's degree in healthcare administration, business, or related field.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) certification is preferred.
• Experience with credentialing software and databases (e.g., CAQH, PECOS, NPPES).

2. Experience:

• Minimum of 3 years of experience in medical credentialing.
• Proven track record in project management, with experience in developing and implementing project plans.

3. Knowledge and Skills:

• In-depth understanding of credentialing standards, regulations, and best practices.
• Strong project management skills with the ability to manage multiple projects simultaneously.
• Excellent organizational and analytical skills, with attention to detail.

4. Communication Skills:

• Exceptional written and verbal communication skills.
• Ability to effectively communicate with internal and external stakeholders.

5. Technology Proficiency:

• Proficient in using credentialing software and Microsoft Office Suite.

6. Adaptability:

• Ability to adapt to changes in regulations and industry standards.
• Willingness to embrace new technologies and methodologies for process improvement.

This position offers an exciting opportunity for a dynamic individual to contribute to the success of our healthcare organization by ensuring the seamless credentialing of healthcare providers while leveraging strong project management skills to optimize processes.