Credentialing Specialist Jobs

Credentialing Specialist

Robert Half

Location:
United States, Southborough

Category:
Health and Beauty

Contract Type:
Employment contract, Contract work

Salary:

Not provided

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Job Description:

We are in search of a skilled Credentialing Specialist to join our team in Southborough, Massachusetts. The successful candidate will play a critical role in the precise processing of credentialing applications and rosters with funders, insurance firms, other payers, and regulatory bodies. This role is pivotal in ensuring that the organization is appropriately reimbursed for the services rendered by its clinical staff.

Job Responsibility:

Collect, review, and validate credentials for healthcare providers, including licenses, certifications, and education
Maintain and update credentialing databases and files for all healthcare providers, ensuring all required documents are current and complete
Adhere to all applicable laws, regulations, and industry standards (e.g., NCQA, CMS, etc.) associated with credentialing
Generate and maintain reports related to credentialing status and compliance and communicate any issues or discrepancies to management
Assist with the enrollment of providers and group facilities into insurance networks and maintain active status with payer organizations
Act as a liaison between healthcare providers, insurance companies, and internal departments to resolve credentialing issues or questions
Participate in internal and external audits of credentialing files, ensuring accurate and timely completion of necessary documentation
Stay informed of changes in regulatory requirements and best practices to ensure the credentialing process remains efficient and compliant
Uphold the dignity and respect of individuals we support and ensure they are treated in accordance with our Human Rights policies
Adhere to all principles related to the Advocates Way
Promote cultural diversity, inclusion, and equity
Perform all duties in accordance with the agency’s policies and procedures

Requirements:

Minimum of 5 years experience as a Credentialing Specialist or a similar role in the healthcare industry
Proficiency in computerized billing systems and electronic health record (EHR) systems
Experience with Epic Software
Solid understanding and experience in accounting functions, specifically in the healthcare setting
Expertise in medical credentialing and medical billing is essential
Proficiency in Microsoft Excel
Demonstrated experience in handling various billing functions
Familiarity with contractual billing, electronic billing, healthcare billing, insurance billing, Medicaid billing, medical insurance billing, Medicare billing, patient billing, physician billing, and third-party billing

What we offer:

medical
vision
dental
life and disability insurance
401(k) plan

Additional Information:

Job Posted:
March 21, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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