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Description

We are in search of a skilled Credentialing Specialist to join our team in Southborough , Massachusetts. The successful candidate will play a critical role in the precise processing of credentialing applications and rosters with funders, insurance firms, other payers, and regulatory bodies. This role is pivotal in ensuring that the organization is appropriately reimbursed for the services rendered by its clinical staff.

Responsibilities:

• Collect, review, and validate credentials for healthcare providers, including licenses, certifications, and education.

• Maintain and update credentialing databases and files for all healthcare providers, ensuring all required documents are current and complete.

• Adhere to all applicable laws, regulations, and industry standards (e.g., NCQA, CMS, etc.) associated with credentialing.

• Generate and maintain reports related to credentialing status and compliance and communicate any issues or discrepancies to management.

• Assist with the enrollment of providers and group facilities into insurance networks and maintain active status with payer organizations.

• Act as a liaison between healthcare providers, insurance companies, and internal departments to resolve credentialing issues or questions.

• Participate in internal and external audits of credentialing files, ensuring accurate and timely completion of necessary documentation.

• Stay informed of changes in regulatory requirements and best practices to ensure the credentialing process remains efficient and compliant.

• Uphold the dignity and respect of individuals we support and ensure they are treated in accordance with our Human Rights policies.

• Adhere to all principles related to the Advocates Way.

• Promote cultural diversity, inclusion, and equity.

• Perform all duties in accordance with the agency’s policies and procedures.

FOR immediate consideration please call me AND Leave a message if needed 508-205-2127 Eric Lebow

Requirements

• Minimum of 5 years experience as a Credentialing Specialist or a similar role in the healthcare industry.

• Proficiency in computerized billing systems and electronic health record (EHR) systems.

• Experience with Epic Software is a must.

• Solid understanding and experience in accounting functions, specifically in the healthcare setting.

• Expertise in medical credentialing and medical billing is essential.

• Proficiency in Microsoft Excel.

• Demonstrated experience in handling various billing functions.

• Familiarity with contractual billing, electronic billing, healthcare billing, insurance billing, Medicaid billing, medical insurance billing, Medicare billing, patient billing, physician billing, and third-party billing.

FOR immediate consideration please call me AND Leave a message if needed 508-205-2127 Eric Lebow

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