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".