Overview Find Your Passion and Purpose as a Provider Credentialing Specialist Reimagine Your Credentialing Career With Us Working for a healthcare company, you know what you do impacts you as much as your field staff supporting our patients and their families. At AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it’s really special to be a part of our patient’s health journey and create incredible memories while providing world-class patient care. Our Investment in You We are committed to offering comprehensive benefits and rewards to full-time employees who work over 30 hours per week and their families, including: ● Medical, dental, and vision coverage ● Paid time off and paid holidays ● Professional development ● Company-matching 401(k) ● Flexible spending and health savings accounts What You Need to Know As a Provider Credentialing Specialist, you will be responsible for ensuring credentialing files are complete and current by gathering, tracking, and completing new and re-credentialing applications of our medical providers with health plans, including Medicare/Medicaid and Commercial. Process contract payments. Manage allocation of group payments. Test and transition manual processes to automated system in HRIS software Weekly/Bi-weekly reconciliation of group timecards. Assess new contracts and contract amendments and make necessary adjustments in applicable software systems Maintain internal provider grid to ensure information is kept accurate and available Maintain close working relationship with Billing and Authorizations Departments to identify and resolve denials and/or authorization issues related to provider credentialing Manage, process and complete requests for; Validation and re-validation issued by government and commercial payer, Credentialing and re-credentialing for commercial payers, Medicare and Medicaid Maintain and update to ensure accurate provider profiles on various databases, including, but not limited to; Council for Affordable Quality Healthcare (CAQH), Provider Enrollment, Chain and Ownership System (PECOS) for Medicare, National Plan and Provider Enumeration System (NPPES), Centers for Medicare & Medicaid Services (CMS) Communicates clearly with providers and/or their liaisons, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise. Will need to maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Compiles and maintains current and accurate data for all providers. Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed. Maintains corporate provider contract files. Maintains knowledge of current health plan and agency requirements for credentialing providers. Sets up and maintains provider information in online credentialing databases and systems. Update license and certification expirations for all providers in CAQH. Ensures practice addresses are current with health plans, agencies, and other entities. Audits health plan directories for current and accurate provider information. Maintains confidentiality of provider information. Demographic Verifications/Quarterly updates in a variety of portals – CAQH, Availity, etc. Work with Finance to resolve Provider not participating claim issues. Qualifications Be the Best Provider Credentialing Specialist You Can Be If you meet these qualifications, we want to meet you! Associates Degree 2+ years of relevant credentialing experience within healthcare required Medicaid/Medicare PECOS enrollment experience required Availity experience preferred Ability to organize and prioritize work and manage multiple priorities Ability to research and analyze data Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization Come As You Are At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging. AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person’s race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.