Credentialing Specialist

USA Clinics Group is growing and seeking a motivated Credentialing Specialist to join our team! The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by Medicare and Medicaid, commercial payers, hospitals, and regulatory agencies.

RESPONSIBILITIES

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications

• Maintain internal provider grid to ensure all information is accurate and logins are available
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Complete re-validation requests issued by government and commercial payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers
• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
• Work closely with the Billing and Authorizations Departments to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on ECHO, CAQH, PECOS, NPPES, and CMS databases
• Other duties as assigned

Requirements

• 1 year of prior credentialing experience in a non-hospital setting, required
• Associates Degree, required, Bachelors Degree, preferred
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Detail oriented with above average organizational skills
• Excellent customer service skills; communicates clearly and effectively

Benefits

• Health
• Dental
• Vision
• 401k
• PTO