Provider Credentialing Specialist

Highmark; United States; On-site; USD 27,000 - 38,000; Full time

Job summary

Highmark is seeking a Credentialing Specialist to process provider applications and re-applications, manage the provider database, and communicate with providers by phone and mail regarding credentialing status.

You will verify information, load credentials into networks, support audits, and participate in projects to improve credentialing functions. A strong focus on accuracy and collaboration with internal teams is required.

Qualifications

• Experience in provider data management, customer services, or claims.
• Good written and verbal communication skills.
• Knowledge of credentialing processes is preferred.

Responsibilities

• Credential and re-credential providers.
• Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications.
• Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor.
• When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database.
• Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met.
• Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures.
• Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues.
• Support projects, audits, business partners, internal departments and external clients.
• Represent department as the Subject Matter expert.
• Pull and research necessary documentation for audits
• Support updates necessitated by our business partners, internal departments and external clients.
• Provide customer oversight for our customers who have unique requirements and timelines to ensure compliance.
• Depending on level, investigate interim license actions.
• Participate in projects which streamline, automate, or otherwise enhance credentialing functions.
• Other duties as assigned or requested.

Skills

Provider data management

Customer service

Claims processing

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File systems

Customer Service inquiry system

Job description

Highmark is seeking a Credentialing Specialist to process provider applications and re-applications, manage the provider database, and communicate with providers by phone and mail regarding credentialing status.

You will verify information, load credentials into networks, support audits, and participate in projects to improve credentialing functions. A strong focus on accuracy and collaboration with internal teams is required.