Credentialing Specialist

Credentialing Specialist

Bethesda MD

Pay From: $25 per hour

MUST:

The Credentialing Specialist should have the following:

2+ years of credentialing providers on the insurance side commercial and Medicaid/Medicare

Entering and updating data from provider applications into credentialing database

Reviewing applications for accuracy and completeness

Handling Primary Source Verification thru any of these sites: OIG, NPBD, CAQH, NPPES and Student Clearing House

Tracking and following-up on verifications in the processing applications

Reviewing and validating documents

Look for discrepancies and correct

Track and follow up on verifications

Comfortable working in a high volume setting

Strong documentation skills and administrative support skills

Organized and detailed

CPCS certification or currently pursuing

High School Diploma or GED

DUTIES:

The duties of the Credentialing Specialist include but are not limited to the following:

Handle credentialing of providers with commercial insurance payers as well as Medicare and Medicaid

Review credentialing applications for accuracy and completeness

Handle Primary Source Verification thru OIG, NPBD, CAQH, NPPES and Student Clearing House

Maintain and update database

Enter and update data from provider applications into credentialing database

Review and validate licensure

Prepare and provide information to payors and staff

Submit the provider rosters to payors with delegated status

Track and follow-up on verifications in the processing of applications

Quadrant is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, or status as an individual with a disability. "Healthcare benefits are offered to all eligible employees according to compliance mandated by the Affordable Care Act".