Hybrid Medical Credentialing Assistant - Detail Oriented

Ivi-America; Bernards Township (NJ); Hybrid; USD 42,000 - 46,000; Full time

Benefits offered by this job

401K Plan

Job summary

IVIRMA Global is seeking a Medical Credentialing Administrative Assistant in Basking Ridge, NJ for a hybrid, full-time position. The role supports practitioners’ insurance credentialing, maintains accurate CAQH profiles, and ensures timely re-credentialing and provider enrollment with health plans.

Responsibilities include creating profiles, following up on discrepancies, submitting initial applications, and coordinating with billing to resolve denials, while maintaining up-to-date provider

Qualifications

• High school diploma, GED, or suitable equivalent.
• 1 year of credentialing experience with medical staff.
• Extremely detail oriented and able to prioritize tasks accordingly.
• Knowledge of medical credentialing and privileging procedures and standards.
• Excellent verbal and written communication skills.

Responsibilities

• Create CAQH profiles for all new providers in our US clinics.
• Identify discrepancies or missing information and conduct follow-ups.
• Update and re-attest each provider profile quarterly and/or as needed.
• Complete and submit initial applications to commercial insurances for participation.
• Notify health plans of provider information/demographical updates and changes as well as practitioner status changes
• Update demographic information and provide supporting documents to outside stakeholders, such as commercial managed care plans.
• Ensure re-credentialing is completed timely to prevent any lapse in enrollment.
• Respond to health plan provider inquiries.
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain individual provider files to include up to date information needed to complete commercial payer credentialing and recredentialing.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.

Skills

Detail orientation

Verbal communication

Written communication

Prioritization

Credentialing experience

Education

High school diploma or GED

Job description

IVIRMA Global is seeking a Medical Credentialing Administrative Assistant in Basking Ridge, NJ for a hybrid, full-time position. The role supports practitioners’ insurance credentialing, maintains accurate CAQH profiles, and ensures timely re-credentialing and provider enrollment with health plans.

Responsibilities include creating profiles, following up on discrepancies, submitting initial applications, and coordinating with billing to resolve denials, while maintaining up-to-date provider