Job Overview & Responsibilities:

The Credentialing Specialist is responsible for obtaining and maintaining payer participation with government and commercial health plans and assisting in enrollment issues as they relate to payer enrollment and claims payment. The Credentialing Specialist will work closely with HR, the clinicians, Clinic Directors and staff to collect all items needed to obtain and maintain all payer participation.

Essential Functions:

• Manage the completion, submission and re-credentialing of provider enrollment applications
• Track current status of applications, follow up as necessary and document activity in an accurate and timely manner
• Prepare the CAQH for newly affiliated and existing providers to include re-attestation
• Research and resolve provider related enrollment issues and coordinate with team members of various departments when applicable
• Maintains confidentiality of provider information
• Maintain the physicians files for revalidation of Medicare via PECOS
• Maintain and update provider files and rosters including but not limited to internal provider and/or location data, individual CAQH profiles, payer databases, NPI database and Medicare database, and any other as needed
• Assist providers with completion of applications and credentialing paperwork
• Advises management team of any potential delays in a providers credentialing and works with billing operations staff in resolving billing issues related to payer credentialing issues
• Review provider credentialing files and work with providers to obtain the necessary missing, incomplete and expiring items
• Proficient in Microsoft Excel
• Stays abreast of current health plan and agency requirements for credentialing providers
• Communicates appropriately with Physicians regarding credentialing and insurance enrollment for new providers and new practices with government and commercial insurance payers

Required Skills & Abilities:

• Ability to type 60 words per minute preferred.
• Physician and Payer Credentialing Experience.
• Great customer service skills.
• Strong interpersonal, oral (includes telephone skills) and written communication skills.
• Ability to manage multiple streams of work simultaneously using good planning, organization, multi-tasking, and prioritization in order to meet deadlines
• Complete understanding of medical reimbursement and terminology.
• Ability to work with disabled individuals.

Required Credentials:

• High School Diploma.
• Minimum two years of experience credentialing for Managed Care Insurance Enrollment, Medicare (PECOS) and Medicaid
• Working knowledge of CAQH Proview
• Knowledge of payer credentialing process, ability to organize and prioritize work and manage multiple priorities, excellent verbal and written communication skills, ability to research and analyze data, work independently, and establish and maintain effective working relationships essential
• Advanced skills with Microsoft applications which may include Echo/One App, Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

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Expanding Access to Quality Care

At PT Solutions, were more than colleagues; were a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact.

Lets go further together and transform care.Join the #PTSLife today!

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