Credentialing Specialist

Credentialing Specialist

BerryDunn is seeking a Credentialing Specialist to join our Healthcare Compliance and Credentialing Practice Area. Under the supervision of the Credentialing leadership team, the Credentialing Specialist will be responsible for all aspects of credentialing/re-credentialing providers, including, but not limited to, verification of application/documents, submission of requests for consideration, initial and revalidation applications, approval, denial, termination letters, primary source verification activities, enrollment, re-enrollment, CAQH maintenance and accurately loading provider information into the Credentialing database. The Credentialing Specialist works closely with the Credentialing leadership and broader Credentialing Team to service clients' needs and meet contractual obligations. This position is planned to be remote.

Travel Expectations: This role requires minimal travel, less than 10% per year.

Responsibilities

• Complete credentialing and/or re-credentialing applications for physicians, ancillary providers and facilities or groups with third-party payers and governmental programs (Medicare and Medicaid) as requested by the client in an accurate and timely manner
• Perform Primary Source Verification (PSV) services including but not limited to verification of licenses, malpractice and work history' perform PSV file audits as requested.
• Complete, update and maintain Council for Affordable Quality Healthcare ("CAQH") profiles for providers
• Maintain a Credentialing database in accordance with BerryDunn's policies and procedures for all participating and non-participating providers with payer identification numbers and effective dates
• Partner with client liaisons, including billing departments to update the enrollment status of the providers
• Contact payers to follow up on submitted applications within BerryDunn's policies
• Respond to various inquiries and requests for information from participating physicians, staff, hospitals, and managed care companies timely and with professionalism
• Communicate with providers or their designees to obtain requisite credentialing information to facilitate timely completion and submission of required documents
• Update client regularly on process and communicate any delays
• Continuously inform Credentialing leadership of the project status and assist in managing expectations related to deliverables and deadlines
• Be responsible for timely and accurately accounting of hours (billable and non-billable) in time and attendance software for proper billing of services rendered

Qualifications

• High school education required, bachelor's degree preferred
• 2-3 years of relevant healthcare experience is required including specialized skills in Credentialing and/or Medical Billing
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Service Management (CPMSM) certification a plus
• Ability to work independently, as well as, in a team setting
• Exceptional organization and time management skills to manage priorities and deadlines
• Effective verbal, interpersonal, and written skills
• Strong attention to detail and quality
• Proficiency with Microsoft Office suite (Word, Outlook, Teams) and Adobe; Excel preferred

Compensation Details

The base salary range targeted for this role is $56,000 - $63,000. This salary range represents BerryDunn's good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.

BerryDunn Benefits & Culture

Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what's expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact View email address on click.appcast.io to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm's tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm.

BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. The firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.