Credentialing Specialist I

Franciscan Alliance, Inc.; United States; Remote; USD 21,000 - 30,000; Full time

Job summary

Franciscan Alliance, Inc. is seeking a Credentialing Specialist I, working remotely from home in the United States.

The role focuses on credentialing and re-credentialing for healthcare providers, ensuring enrollment with multiple payers and CAQH attestations, while maintaining high-quality data in credentialing databases. The position requires at least 1 year in payer enrollment or credentialing within healthcare, strong organizational skills, and proficiency with MS Office and EHR systems.

Qualifications

• High School Diploma/GED required.
• 1 year experience in payer enrollment, credentialing, or related healthcare field is required.
• Strong organizational and multitasking abilities with keen attention to detail.
• Proficiency in Microsoft Office Suite and experience with EHR systems; familiarity with payer policies.

Responsibilities

• Track and document credentialing status and input provider data into databases.
• Fulfill requests for provider data to health plan organizations.
• Process re-credentialing for physicians with commercial plans and CAQH attestation.
• Coordinate administrative activities for payer applications and attestations; manage initial mailing and loading into tracking systems.
• Submit applications to various payers and follow up on status.
• Communicate with internal and external customers including bi-weekly calls and payer calls to discuss discrepancies.
• Research payer denials and issues related to credentialing activities.
• Research Payor processes and participation in Payor plans.
• Compile, review, and submit credentialing files to ensure compliance with federal/state standards.

Skills

Organizational skills

Multitasking

Communication skills

Interpersonal skills

Microsoft Excel

Microsoft Word

PowerPoint

EHR experience

Education

High School Diploma or GED

Tools

Microsoft Office Suite

EHR systems

Job description

Work From Home

Work From Home Work From Home, Indiana 46544

The Credentialing Specialist I coordinates and maintains medical service provider insurance plan enrollments, ensuring healthcare professionals and services meet all established federal and state standards. This position conducts the credentialing and re-credentialing provide documentation related to education, training of healthcare practitioners, as well as processes payer enrollment and re-credentialing with various insurance plans.

WHO WE ARE

Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU WILL DO

• Track and document credentialing status/application status changes routinely with participating and non-participating payers; perform data entry of provider data into credentialing databases.
• Fulfill requests for provider data to health plan organizations.
• Process the re-credentialing of established physicians with commercial, managed care plans, and attestation for CAQH.
• Coordinate and perform administrative activities to process provider payer applications, re-applications, and attestations, including initial mailing, review, and loading into the database tracking system ensuring high-quality standards are maintained.
• Complete application submissions with various payers and conduct subsequent status follow-up activities throughout the process.
• Communicate with internal and external customers, which include bi-weekly calls with operational customers and Payor calls to communicate discrepancies.
• Research denials with internal and external customer issues related to credentialing activities.
• Research the Payor processes and online Payor participation in the Payor plans.
• Inquire, compile, review and submit application file as part of the credentialing and re-credentialing process to make certain healthcare professionals and services meet all established federal and state standards.

QUALIFICATIONS

• Required High School Diploma/GED
• 1 year experience in payer enrollment, credentialing, or a related field within a healthcare setting Required
• 1 year Strong organizational and multitasking abilities, with a keen attention to detail. Excellent communication and interpersonal skills, capable of building relationships with diverse stakeholders. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and experience with electronic health record (EHR) systems. Familiarity with healthcare regulations and payer policies Required

TRAVEL IS REQUIRED:

Never or Rarely

JOB RANGE:

Credentialing Specialist I $15.50-$21.88

INCENTIVE:

Not Applicable

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on thebenefit section of our career site, jobs.franciscanhealth.org.