Part-Time Credentialing Specialist

Socket.dev; Waynesboro (TN); On-site; USD 25,000 - 33,000; Part time

Job summary

Socket.dev in the United States (Tennessee, Waynesboro) is seeking a Provider Credentialing Specialist to join our urgent care/primary care team. You will manage provider credentialing, licensure, and payor enrollment to ensure smooth billing operations.

The role involves enrolling providers with payors and clearinghouses, CAQH/credentialing maintenance, updating CAQH, payor panels, and coordinating with HR for onboarding.

Qualifications

• 2+ years’ experience in a medical office with claims, billing, and medical records is an asset.
• 2 years of credentialing required.
• Proficient with MS Word and MS Excel; HIPAA knowledge.

Responsibilities

• Enroll providers with necessary payors and clearinghouse to ensure claims can be billed correctly.
• Handle contracting, revalidating Medicare/Medicaid enrollment, CAQH, and re-credentialing maintenance.
• Collect and confirm provider information for accrediting and licensing reports; maintain provider database.
• Coordinate with billing to ensure non-compliant or questionable claims are detected.

Skills

Credentialing

HIPAA

MS Word

MS Excel

Attention to detail

Teamwork

Education

Associate Degree

Certified Professional Biller/Coder preferred

Job description

Description

Provider Credentialing Specialist -

We are seeking a Provider Credentialing Specialist to become a part of our team working in the urgent care/primary care setting. Your main focus will be providing high-quality, efficient provider credentialing. You will obtain licensure and credentials from providers, verify past credentials, and ensure the billing process runs smoothly.

Key Tasks and Responsibilities:

• Enroll providers with the necessary payors and the clearinghouse to ensure claims can be billed correctly.
• Handle contracting, the revalidating of Medicare and Medicaid enrollment, CAQH, and any re-credentialing maintenance.
• Responsible for collecting and confirming provider information in order to process and file reports with accrediting and licensing agencies as well as maintaining a database of provider information.
• Coordinate with our billing department to ensure that processes are in place to detect non-compliant or questionable claims.
• Review clearinghouse and claims data for rejections. Identify and correct provider credentialing issues.
• Maintain, review, and update provider credentialing with all payors. Review prior credentialing applications for errors and correct as needed.
• Assist working denials due to credentialing issues.
• Maintain MODIO provider certification system.
• Maintain CAQH profiles for all providers.
• Update payor panels.
• Update insurance eligibility websites such as Availity and Trizetto.
• Assist with onboarding new hires with HR to ensure candidates have completed and submitted all required documents prior to onboarding.
• Ensures that provider medical licenses, board certifications, DEA and other pertinent information is renewed prior to expiration.
• Manages and maintains relationships with all payors to improve revenue.
• Performs all other contracting and maintenance needs required by payors.
• Experienced with MS Word and MS Excel, knowledge of HIPAA, ability to work independently and as a team.
• Able to multi-task, prioritize, and meet deadlines. Self motivated and able to stay on task.
• Working knowledge of healthcare insurance rules and guidelines.
• Understanding of RHC credentialing rules and guidelines.
• Must maintain regular and sustained attendance.
• Experienced with MS Word and MS Excel, knowledge of HIPAA, ability to work independently and as a team.
• Knowledge of office equipment to include fax, scanner, and copy machine.
• Excellent computer and data entry skills.

Schedule

• 15 to 25 hours per week
• Varying 8 hour shift
• Varying Monday to Friday

Education and Experience

• Associate Degree preferred
• Certified Professional Biller or Certified Professional Coder preferred
• 2+ years’ experience in a medical office with experience in claims, billing, insurance, and medical records is an asset
• 2 years of credentialing required

Equal Opportunity Statement

QuickVisit is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment that is free of harassment, discrimination, or retaliation because of age (40 and older), race (including discrimination on the basis of a person's hair texture or protective hairstyle commonly or historically associated with race, such as braids, locks, and twists), color, national origin, ancestry, religion, creed, sex, sexual orientation (including transgender status, gender identity or expression), pregnancy (including childbirth, lactation, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics), marital status, AIDS/HIV status, veteran status, uniformed servicemember status, or any other status protected by federal, state, or local laws. The Company is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.