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Credentialing Specialist

Company: Thriveworks
Location: Raleigh
Posted on: November 22, 2021

Job Description:

Credentialing SpecialistThe Credentialing Specialist will be required to complete the credentialing, re-credentialing and payor enrollment processes for providers with contracted insurance companies and other accrediting entities. In addition, they will maintain current data for each provider to ensure timely renewal of credentialing, licensing and certification. This position is full-time with competitive salary and benefits. If you are looking for a lifestyle employment opportunity providing you with dynamic team support, this may be the opportunity for you!Thriveworks is a growing company that provides a challenging, welcoming, and rewarding place to work. A good candidate will be able to grow in responsibility and in their role as the company grows.Duties and Responsibilities:Review and process providers' initial applications and supporting documentation to identify possible issues. Follow up with healthcare provider as needed to obtain missing information.Complete and process payer enrollment applications for healthcare providers for Medicare, commercial managed care, and other identified plans in the market.Complete timely follow up on all payer enrollment applications.Maintain accurate provider profiles on CAQH, PECOS, NPPES, and in credentialing software.As directed, provide updated demographic information with supporting documents to outside stakeholders, such as commercial managed care plans and contracted billing entities.Completing and coordinating paperwork for ERA, EDI, and EFT between the organization and payers.Ensure that re-credentialing is completed timely to prevent any lapse in enrollment.Monitor and maintain current expirable documents (License, DEA, Board Certifications, Malpractice).Terminating enrollment with government and commercial payers upon resignation or termination of providers.Complete primary source verification and prepare files for committee review.Establish and maintain long-term working relationships with payors..Maintains confidentiality of provider information.Requirements:Associates Degree or 3 years of credentialing experience.Excellent verbal and written communication.Detail OrientedHave the ability to manage workflow to meet deadlines.Able to work as part of a team and independently.Self-motivated to achieve goals.Outside the box thinkers; and excellent at problem solving.Enthusiastic about being part of an organization that recognizes your talent.Ability to maintain consistent contact with healthcare providers and insurance companies to ensure that expectations are clear and requirements are completed in a timely manner.Experience working with credentialing software, eVIPs, preferred.Benefits:Hourly rate will be determined by experience with potential to bonusExtremely competitive compensation and benefit package.Performance bonuses.Health, Dental and Vision insurance, with employer match.401K with 3% employer match.Company sponsored events are always on the horizon.Professional development & advancement opportunities!Apply today at the country's leading mental health counseling practice - Thriveworks!Learn more about Thriveworks' mission and core values at

Keywords: Thriveworks, Raleigh , Credentialing Specialist, Other , Raleigh, North Carolina

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