Duration:
6 months to start
Job Description:
Key Responsibilities:
- Process and track initial payer credentialing, provider enrollment, recredentialing, and revalidation applications for participating providers.
- Support behavioral health provider enrollment and credentialing, including collecting and reviewing payer-required documentation.
- Prepare, assemble, review, and quality-check provider applications; follow up with providers and payers to resolve missing or inconsistent information.
- Conduct credential verification and mandated queries as assigned, in accordance with policies and applicable payer requirements.
- Enter, review, maintain, and update provider information in credentialing databases, CAQH, and payer systems.
- Cleanse and validate credentialing/provider records to support the MD-Staff transition, identifying incomplete, outdated, or inconsistent data and coordinating corrections.
- Monitor provider expirables, enrollment status, recredentialing deadlines, and payer revalidation cycles; maintain accurate documentation and status tracking.
- Communicate with providers, practice managers, medical staff offices, and payer representatives to facilitate timely credentialing and enrollment.
- Prepare reports and updates for downstream billing/system maintenance; support resolution of enrollment-related claim issues.
- Protect confidential provider information and follow organizational privacy, compliance, and quality procedures.
- Perform other related duties as assigned.
Preferred Experience
- Independent end-to-end payer enrollment: preparing and submitting applications, tracking payer responses, resolving deficiencies, and maintaining provider participation records.
- Behavioral health provider credentialing/enrollment; experience with specific provider types and payer requirements.
- Credentialing data cleansing, duplicate/incomplete record resolution, data validation, reconciliation, and quality checks for a system transition, ideally involving MD-Staff.
- Hands-on Cactus or MD-Staff; both systems preferred.
- Initial credentialing, recredentialing, primary source verification, NPDB queries, CAQH profile maintenance/re-attestation, and Medicare/Medicaid revalidations.
Required Qualifications
Education:
- High School Diploma or GED required
- Associate degree preferred
Experience:
- Minimum 2 years of relevant experience required.
- Direct, hands-on payer credentialing and provider enrollment experience is strongly preferred, particularly in behavioral health.
Certifications:
- Certified Provider Credentialing Specialist (CPCS) preferred
Technical Skills:
- Proficient computer and data-entry skills
- Ability to maintain accurate credentialing/provider records and work with electronic systems.
- Experience with Cactus, MD-Staff, CAQH, and payer portals strongly preferred as applicable.
Other Requirements:
- Strong attention to detail
- Organizational skills
- Confidentiality
- Independent workload management
- Clear communication with providers, practices, payers, and internal teams.
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