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SalaryHygea Healthcare is hiring immediately!!! We are opening several substance abuse treatment centers in the Baltimore Area and we are looking for an experiencing Credentialing Specialist who can establish network contracts, maintain our provider profiles and maintain our CAQH records for our providers.
No relocation offered.
Job Summary
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.
Essential Job Functions
- 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.
- Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe.
- Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
- 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.
- Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
- Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Other duties as assigned.
Education and Experience
- High School Diploma or equivalent.
- 2 years’ credentialing experience preferred.
- 2 years’ experience in a medical practice business office role
