Credentialing Specialist

Credentialing Specialist 

Brief Description:

As a Credentialing Specialist you will manage the relationships between the company and the insurance companies in the United States and ensure the project has all the necessary accreditations in order to provide services. Attention to detail is essential. 

Reporting to:

• Service Delivery Manager 

• CEO

Main responsibilities:

• Create and maintain licensing, credentials and insurance records

• Conduct the necessary steps to obtain credentialing for the facilities and providers of the company

• Update the insurance databases with the provider profiles in order to generate leads

• Conduct research on updated state and federal regulations and policies

• Release information to requesting agencies and public inquiries when required by law

• Help develop internal credentialing processes

• Monitor license and credential expiration dates and advise staff members of required “renew by” dates

• Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions

Key competencies:

• Minimum 2 years experience in a call center environment 

• Excellent computer skills

• Exceptional skills in Excel, Google Sheets, and similar applications for data analysis and reporting

• Hands on experience in using CRM softwares 

• Strong attention to detail is a must

• Customer service skills 

• Ability to time manage with very little supervision

• Ability to work in a team environment

• Ability to meet deadlines 

• Ability to be self-organized and prioritize tasks

• Ability to research information and use online tools to add to their industry knowledge

• Excellent English communication skills, both verbal and written (C1 level) - mandatory

Nice to have:

• Understanding of the medical insurance policies in the United States

• Previous experience in billing