Credentialing Specialist

CUMBERLAND FAMILY MEDICAL CENTER IN; Russell Springs (KY); On-site; USD 36,000 - 52,000; Full time

Benefits offered by this job

Health

Vision

Dental

Life

STD

LTD

401K

PTO

Holidays

Job summary

Cumberland Family Medical Center (CFMC) in Russell Springs, KY is hiring a Credentialing Specialist for full-time, on-site work. The role supports credentialing processes with contracted payers, maintains provider records, and ensures accurate reporting and compliance.

Strong MS Office skills and communication are essential. Two years related experience or equivalent required; excellent teamwork and attention to detail are expected in a busy health-center setting offering comprehensive benefits

Qualifications

• High school diploma or GED required.
• Minimum of 2 years’ credentialing experience or equivalent.
• Strong communication and organizational skills.
• Proficient with MS Outlook, Excel and Word.

Responsibilities

• Enroll physicians with contracted payers and maintain records for credentialing.
• Maintain provider listings with Medicare, Medicaid and other carriers.
• Initiate credentialing with payers and manage relationships with providers.
• Set up and maintain provider and group records.
• Maintain credential databases and time-based reporting.
• Review credentialing applications for completeness and accuracy.
• Communicate and track applications with payers for timely credentialing.

Skills

Excellent communication

MS Outlook

MS Excel

MS Word

Education

High school diploma/GED

Job description

Job Details: Job Location: Cumberland FMC Admin - Russell Springs, KY 42642, Position Type: Full Time, Job Category: Admin - Clerical, Credentialing Specialist

Cumberland Family Medical Center (CFMC) operates a Federally Qualified Health Center (FQHC) offering a wide range of health and social services at multiple sites throughout Kentucky. We seek employees who support our mission and who actively contribute to our service-driven environment by enhancing patient experience and improving productivity. CFMC offers compassionate care, uncompromising service and clinical excellence. We offer a collaborative environment with excellent benefits, wage/salary commensurate with experience and relevant work experience.

Duties and Responsibilities:

• Enrolls physicians with contracted payers and maintains current and organized records of all credentialing information to include completing applications, obtaining signatures, providing necessary documents to complete the credentialing process.
• Maintains provide listings with Medicare, Medicaid, and other carriers.
• Performs initial contact with contracted payers to initiate credentialing process and enable a relationship with the provider and network representatives.
• Maintain and update accurate reports regarding provider participation.
• Responsible for setting up and maintaining provider and group records.
• Maintains credential database in accordance with time standards.
• Reviews credentialing applications for completeness and accuracy of documentation according to specified standards for submission to insurance carriers for credentialing.
• Communicates and tracks applications with payers to ensure timely and accurate credentialing of providers.
• Review records for completeness, accuracy and compliance with regulations.
• Maintain and update accurate reports regarding provider participation.
• Other duties as assigned.

Qualifications: Education/Experience:

• High school diploma/GED.
• A minimum of 2 years’ related experience in credentialing or equivalent combination of education and experience.
• Must have good communication skills.
• Proficient in MS Outlook; MS Excel and MS Word.

Schedule Requirements:

Full-time position, 5 days per week, 100% office-based, in person work required.

Work schedules are set at the discretion of CFMC and may be adjusted at any time based on the operational needs of the organization.

Compensation:

Negotiable based on experience

Benefits:

Health, Vision, Dental, Life, STD, LTD, 401K, PTO, and Holidays