Credentialing Specialist – WFH Anywhere

Job Expired

About The Company

Tollanis Solutions is a Managed IT Service provider that provides the technological tools, expertise, and solutions needed for an organization to thrive. Working with our partner Credentially, Tollanis is committed to transforming the way healthcare organizations carry out recruitment by providing them with an innovative IT solution that will streamline hiring, onboarding, and compliance for greater efficiency and ROI.

The Vacancy We Are Hiring

We are looking to hire an organized Credentialing Specialist to conduct all aspects of third party credentialing for our clients. The Credentialing Specialist will organize, maintain, and verify all aspects of the process, and maintain current files on physicians, nurses and other applicants. You will track the expiration of certifications to maintain up-to-date files, and assist both clients and applicants with phone inquiries. To be successful in this role you should ensure the currency and accuracy of all information. Preferred candidates will be reliable, energetic, and have excellent people skills.

Responsibilities: 

  • Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements.
  • Process and file applications with third party payors according to each payors individual requirements and addresses/corrects discrepancies as requested by payors.
  • Conduct all follow up steps till payor approval/completion is obtained.
  • File provider practice change notifications and perform follow up duties till confirmed complete by payors.
  • Update NPI records according to provider specifications.
  • Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
  • Track provider licensure and Board expirations and ensure timely processing CAQH, TMHP and payor updates.
  • Complete requests for re-credentialing for both providers and facilities.
  • Accept and process all requests from payers for credentialing information/updates/new contracts and products
  • Answer questions, process requests from clients & applicants related to credentialing information.
  • Prepare and maintain facility credentialing files and reports including maintenance of credentialing software, facility rosters and spreadsheets.
  • Ensure all records meet standards set by carriers as well as FQHC guidelines
  • Enrolls facilities in Medicare/Medicaid programs.
  • Address enrollment disconnects with internal and external stakeholders
  • Assist with EHRS enrollment, tracking and filing
  • Maintains quarterly payor specific rosters in accordance to CMS standards
  • Assist in quarterly CAQH mass attestation

 

Required Skills and Professional Expertise:

  • Knowledge of medical credentialing and privileging procedures and standards.
  • Excellent, clear verbal & written communication skills
  • Detail oriented and organizational skills
  • Ability to focus for extended periods
  • Ability to investigate and analyze information and draw conclusions.
  • Ability to process computer data and to format and generate reports.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Experience working as part of a remote team.

Qualifications:

  • Minimum of 5 years experience as a Credentialing Specialist or Coordinator 
  • Bachelor’s degree preferred
  • NAMSS Certification/Licensure as a Certified Provider Credentials Specialist (CPCS) is a plus

What We Offer

  • Work from Home – we are a remote first organization 
  • Ability to advance in a fast growing IT startup 
  • Competitive salary in USD commensurate with experience 

Individuals seeking employment at Tollanis Solutions are considered without regard to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation.

More Information

  • This job has expired!
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Tollanis Solutions

Empowering Change Through Process And People

Our Location:

200, Yuhyeon-ro, Gimpo-si, Gyeonggi-do, South korea