Credentialing Specialist (Fully Remote)

SimiTree Healthcare Consulting; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

Join a forward-thinking organization as a Credentialing Specialist, where you will play a key role in supporting healthcare providers through the credentialing process. This fully remote position offers the opportunity to work with a dedicated team, ensuring compliance and efficiency in provider enrollment. You will utilize your advanced software skills and customer service expertise to manage multiple tasks and meet deadlines effectively. Enjoy a competitive compensation package, including health benefits and professional development opportunities, while making a significant impact in the healthcare sector.

Benefits

Health Insurance

Vision Insurance

Dental Insurance

PTO

401K Retirement Plan

Paid Holidays

Life Insurance

Sick Time

Professional Development Opportunities

Qualifications

• 2+ years of provider credentialing experience with knowledge of payer policies.
• Advanced software skills, particularly in Microsoft Suite applications.

Responsibilities

• Process credentialing and re-credentialing applications for providers.
• Monitor and track applications with payers until completion.

Skills

Credentialing

Microsoft Word

Microsoft Excel

Customer Service

Time Management

Education

Associate Degree

Tools

Microsoft Outlook

Microsoft Teams

Job description

Credentialing Specialist (Fully Remote)

The Credentialing Specialist will perform as the Provider Enrollment Specialist to ensure the team is poised to support the business leaders in their accordance with the company’s strategic plans and objectives.

About SimiTree
SimiTree provides client-centric services to home health, hospice, private duty, pediatrics, applied behavioral analysis, palliative care, and other post-acute organizations. Our organization is made up of clinical, operational, and revenue cycle experts who support our clients. SimiTree has developed a full suite of custom-designed services focusing on areas critical to quality improvement, operational efficiency, accurate reimbursement, and regulatory compliance.

To provide our clients with an opportunity to focus on core operations, SimiTree provides outsourcing services for Coding and OASIS reviews, Billing and Collections, and full Revenue Cycle services. SimiTree's client base ranges from small, community-based agencies to publicly traded national chains. We have both the technical expertise and the real-world experience to implement seamless solutions that assist agencies in a rapidly changing operational and regulatory environment.

Duties/Responsibilities:

• Process initial credentialing and re-credentialing applications for providers and practice groups.
• Monitor, track and follow up on all applications with payers until completion of the process.
• Screen providers’ applications and supporting documentation to ascertain their eligibility.
• Accurately maintain internal credentialing tracking system with provider and payer participation information.
• Identify discrepancies in information and conduct follow ups.
• Capture primary source verification documentation.
• Build knowledge base for payer requirements and forms.
• Ensure compliance with applicable laws regulations, procedures, and policies.
• Perform CAQH updates and attestations as needed.
• Work with internal RCM team members to identify and resolve credentialing issues and denials.
• Work closely with the Account Success Team for any client credentialing requirements
• Work closely with the Account Success Team and Business Development to onboard new clients and ensure accurate registration with appropriate payers

Competencies/Behaviors:

• Advanced software and computer skills including Microsoft Suite applications; specifically, Word, Excel, and PowerPoint is required.
• Excellent time management skills, experience of working on multiple tasks, being able to manage busy workloads, prioritizing accordingly and meeting deadlines.
• Strong customer service skills and ability to interact with employees at all levels throughout the organization, also with external clients when appropriate
• Self-starter with a positive, “can-do” and professional approach.
• Ability to comprehend, interpret, and apply the appropriate sections of applicable laws, guidelines, regulations, and policies.
• Minimum of Associate degree or equivalent combination of education and experience in Credentialing
• 2+ years provider credentialing experience with knowledge of payer policies for multiple states.
• Experience working in Microsoft Outlook and TEAMS preferred.
• Experience working in a fully remote setting preferred.

Physical Requirements:

• Activities requiring a significant amount of sitting at office and work desks in front of a computer monitor.
• Regularly required to verbally communicate, listen, and give presentations as needed.

The physical requirements are representative of those that must be met by an employee to successfully perform the essential function of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Salary range/ Benefits:
$20.00- $22.00 per hour

The compensation scale listed is a general salary range and is not intended to represent the actual annual or hourly compensation rate for this role. An offer will be made to the selected candidate at the conclusion of the interview process based on their relevant experience and the responsibilities of the position. SimiTree offers a competitive compensation package including health, vision, and dental insurance, PTO, retirement plans (401K), holiday paid time off, life insurance, sick time, and opportunities for professional development.

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