Medical Credentialing and Billing Specialist - MediTelecare

POSITION DESCRIPTION:

We are seeking a meticulous and detail-oriented Credentialing Specialist to join our team. The ideal candidate will be responsible for primary sourcing and verifying clinician credentials, ensuring compliance with regulatory standards, and maintaining accurate documentation of credentials. The Credentialing Specialist will work to facilitate timely record-keeping and assist clinicians and facilities with credentialing and licensing needs.

ESSENTIAL FUNCTIONS:

• Primary sourcing of clinician credentials, including licensing, education verification, and other relevant documentation.
• Maintain up-to-date records of clinician credentials and ensure timely renewal of licenses and certifications.
• Collaborate with HR to facilitate the timely collection of immunization records, identification verification, background checks, and drug screenings.
• Communicate directly with clinicians and facilities to obtain necessary documentation and provide assistance with credentialing and licensing processes.
• Verify clinician for any sanctions from OIG, SAM, and Medicare Opt Outs.
• Assist in obtaining current collaborative agreements for nurse practitioners, ensuring compliance with regulatory requirements.
• Responsible for scanning credentialing and enrollment correspondence, and sharing pertinent information with enrollment, billing, and intake teams.
• Other duties as assigned.

EDUCATION, EXPERIENCE AND LICENSING:

• Certified Credentialing Specialist Certification (preferred)
• Proven experience in credentialing or related administrative roles within the healthcare industry for at least 3 years
• Proficiency in database management, such as CAQH & NPDB querying
• Full understanding of NPPES & PECOS platforms
• Strong understanding of regulatory requirements and standards related to clinician credentialing.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Excellent communication skills with the ability to interact professionally with clinicians and internal staff.
• Exceptional attention to detail and organizational skills.
• Proficiency in Microsoft Office, especially Excel, Outlook, Word & Teams
• Ability to work independently and collaboratively in a fast-paced environment to meet strict deadlines.

WORKSPACE REQUIREMENTS:

• Home-based office space, free of distractions
• Strong, reliable Internet access
• Dedicated cellular phone