Credentialing Specialist

Quadrant, Inc.; Bethesda (MD); On-site; USD 28,929 - 39,950; Full time

Job summary

Quadrant, Inc. in Bethesda, MD is seeking a Credentialing Specialist to support credentialing for providers with commercial, Medicare and Medicaid payers. The role involves data entry, application review, and ongoing verification activities to ensure accuracy and completeness.

The position requires 2+ years in credentialing, strong documentation skills, and the ability to manage high-volume workloads. A CPCS certification or pursuit is preferred, with a high school diploma or GED required.

Qualifications

• 2+ years of credentialing experience on the insurance side (commercial and Medicaid/Medicare).
• Entering and updating data from provider applications into credentialing database.
• Reviewing applications for accuracy and completeness.
• Handle Primary Source Verification through OIG, NPBD, CAQH, NPPES and Student Clearing House.

Responsibilities

• Handle credentialing of providers with commercial payer, Medicare and Medicaid.
• Review credentialing applications for accuracy and completeness.
• Perform Primary Source Verification via OIG, NPDB, CAQH, NPPES and Student Clearing House.
• Maintain and update credentialing database.
• Enter data from provider applications into credentialing system.
• Review and validate licensure.
• Provide information to payors and staff.
• Submit provider rosters to payors with delegated status.
• Track and follow up on verifications in processing of applications.

Skills

Credentialing

Data entry

Documentation

Attention to detail

Organization

Communication

Verification sites

High volume

Administrative support

Education

CPCS certification

High School Diploma or GED

Job description

Credentialing Specialist

Bethesda MD

Pay From: $25 per hour

Musts

• 2+ years of credentialing providers on the insurance side commercial and Medicaid/Medicare
• Entering and updating data from provider applications into credentialing database
• Reviewing applications for accuracy and completeness
• Handling Primary Source Verification thru any of these sites: OIG, NPBD, CAQH, NPPES and Student Clearing House
• Tracking and following-up on verifications in the processing applications
• Reviewing and validating documents
• Look for discrepancies and correct
• Track and follow up on verifications
• Comfortable working in a high volume setting
• Strong documentation skills and administrative support skills
• Organized and detailed
• CPCS certification or currently pursuing
• High School Diploma or GED

Duties

• Handle credentialing of providers with commercial insurance payers as well as Medicare and Medicaid
• Review credentialing applications for accuracy and completeness
• Handle Primary Source Verification thru OIG, NPBD, CAQH, NPPES and Student Clearing House
• Maintain and update database
• Enter and update data from provider applications into credentialing database
• Review and validate licensure
• Prepare and provide information to payors and staff
• Submit the provider rosters to payors with delegated status
• Track and follow-up on verifications in the processing of applications

Quadrant is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, or status as an individual with a disability.

"Healthcare benefits are offered to all eligible employees according to compliance mandated by the Affordable Care Act".