Credentialing Specialist: Provider Enrollment

Beacon Behavioral Partners; United States; On-site; USD 50,000 - 75,000; Full time

Job summary

Beacon Behavioral Partners in Plano, TX is seeking a Credentialing Specialist to join our Revenue Cycle Team. This full-time onsite role focuses on provider enrollment, credentialing databases, and ensuring accurate primary source verification.

Ideal candidates have a bachelor's degree in healthcare administration and at least 3 years of credentialing experience, with strong communication and organizational skills; CPCS is a plus.

Qualifications

• Bachelor's degree in healthcare administration, business administration, or related field preferred.
• Minimum of 3 years of experience in provider enrollment and credentialing.
• Extensive knowledge of provider enrollment regulations and guidelines, including Medicare, Medicaid, and commercial payer requirements.
• Strong understanding of credentialing processes and best practices.
• Experience with various payer enrollment portals and systems.
• Excellent communication, interpersonal, and organizational skills.
• Ability to manage multiple projects simultaneously and meet deadlines.
• Detail-oriented and highly accurate.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
• Certified Provider Credentialing Specialist (CPCS) certification preferred.

Responsibilities

• Compiling and maintaining current and accurate data for all providers.
• Data entry and maintaining provider information in online credentialing databases and system.
• Primary source verification of State license, DEA, and Board certification.
• Completing provider initial and re-credentialing applications.
• Audits applications for accuracy and completeness.
• Submitting credentialing applications and supporting documentation to payers.
• Monitoring application progress and following up with payers until in-network status is received.
• Maintaining copies of licenses, DEA certificates, malpractice coverage and expirations.
• Tracking CME and providing quarterly updates to providers.
• Assists in training and monitoring credentialing specialists, assigning work and reviewing for accuracy.
• Assist in streamlining credentialing process, onboarding and offboarding.
• Escalate personnel issues to Credentialing Supervisor.
• Report enrollment issues to RCM leadership.
• Maintain billing insurance grid and provider spreadsheets.

Skills

Communication

Interpersonal skills

Organizational skills

Analytical skills

Attention to detail

Problem solving

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office

Job description

Beacon Behavioral Partners in Plano, TX is seeking a Credentialing Specialist to join our Revenue Cycle Team. This full-time onsite role focuses on provider enrollment, credentialing databases, and ensuring accurate primary source verification.

Ideal candidates have a bachelor's degree in healthcare administration and at least 3 years of credentialing experience, with strong communication and organizational skills; CPCS is a plus.