Credentialing Specialist - Hybrid

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required with commercial payers, Medicare, and Medicaid. Essential Functions & Responsibilities

: Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications. Maintain internal provider grid to ensure all information is accurate and logins are available. Update each provider’s CAQH database file timely according to the schedule published by CMS. Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid. Complete re-credentialing applications for commercial payers. Credential new providers and re-credential current providers. Work closely with the Finance department and billing staff to identify and resolve any denials or authorization issues related to provider credentialing. Maintain accurate provider profiles on applicable carrier databases. Other duties as assigned. Knowledge, Skills and Abilities: Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle. Excellent computer skills including Excel, Word, and Internet use. Detail-oriented with above-average organizational skills. Plans and prioritizes to meet deadlines. Excellent customer service skills; communicates clearly and effectively. Education/Experience Required

: High School Diploma or GED. 2 years credentialing experience preferred. Aspects of Performance: Supports the philosophy of CHWC and complies with the Center’s policies and procedures. Maintains confidentiality, adheres to CHWC Corporate Compliance Program. Interacts effectively with groups and individuals; open honest communication; addresses issues professionally while directing to the appropriate departments. Organizational skills to manage workload efficiently, initiative/ability to prioritize conflicting demands, ability to self-start – work with minimum supervision. Exercises judgment in making independent decisions within the scope of responsibilities; ability to problem-solve and use good judgment on a case-by-case basis. Reliable, dependable, and detail-oriented. Demonstrates enthusiasm and commitment toward job and mission of the agency. Ability to act and operate independently with minimal daily direction from manager to accomplish objectives. Ability to work cooperatively and collaboratively with all levels of employees, management, and external agencies to maximize performance, creativity, problem-solving, and results. Experience working in a Federally Qualified Healthcare Center (FQHC) preferred. Additional General Requirements

: Professional positive attitude, understanding of customer service principles, trustworthiness, and excellent interpersonal skills. Job Qualifications/Requirements

: Education

: High School Diploma or GED. Experience

: 2 years credentialing experience preferred. Language Skills

: Must speak, write, and read English proficiently. Spanish preferred but not required. Teleworking

: This position requires teleworking if requested. Community Health and Wellness of Greater Torrington, Inc. #J-18808-Ljbffr