[Hiring] Credentialing Specialist I, II, III @TeleMed2U

Role Description

The primary role of this position is to assist physicians and support the Credentialing team with preparing and submitting credentialing, enrollment, recredentialing applications and follow up on the status of applications for Physicians and Payers and keep a detailed log of all tasks. The Credentialing Specialist will be responsible for supporting all aspects of credentialing and recredentialing and any other administration duties assigned by management.

Credentialing Specialist I:

• Supports the TeleMed2U Provider Network’s credentialing process for all TeleMed2U clinical providers, in accordance with NCQA, URAC, Joint Commission and CMS accreditation standards, Federal and State laws, and TeleMed2U’s policies.
• Assists with the management of TeleMed2U Provider Network’s credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process.
• Ensures all credentialing and enrollment applications accuracy prior to submission.
• Monitors provider enrollment application status, follow up with the payors.
• Manage CAQH profiles for TeleMed2U’s Provider Network.
• Prepare and submit rosters to health insurance plans to ensure provider participation.
• Update various databases to ensure proper tracking of payor enrollments, credentialing and update requests.
• Maintain necessary records of outstanding enrollment applications and requests.
• Coordinate all managed care credentialing activities to ensure provider participation status.
• Credentialing activities require substantial contact with outside agencies.
• Maintain Credentialing database.
• Follow-up with managed care companies to ensure expedient credentialing.
• Remains current on policies affecting provider enrollment credentials & delegated clients/payers.

Credentialing Specialist II:

• All Credentialing Specialist I responsibilities.
• Serve as a liaison for training new team members.
• Identify conflicting or questionable information while processing applications and highlight sensitive information for committee members.

Credentialing Specialist III:

• All Credentialing Specialist I and II responsibilities.
• Acts as a mentor to other Credentialing Specialists.
• Provides support and assistance within the department.
• Leads with minimal supervision.
• Prepare specialized reports as requested, including analysis and presentation findings.
• Other duties as assigned.

Qualifications

• Credentialing experience.
• High School Diploma or equivalent.
• 3 years of experience in credentialing (for Credentialing Specialist II).
• 1 year minimum healthcare experience (for Credentialing Specialist II).
• Credentialing Specialist II with TeleMed2U minimum 1 year (for Credentialing Specialist III).
• 4 years experience minimum in Credentialing and/or Licensing (for Credentialing Specialist III).
• Top performer at current level, who has demonstrated proficiency in all areas of Credentialing.
• Excellent verbal and written communication skills.
• Ability to multitask and work independently.
• Excellent attention to detail.
• Experience with state licensure application submission process for multiple states.
• High school diploma required/GED.

Preferred

• Medicare and Medicaid enrollment experience preferred.
• Bachelor’s degree preferred.
• 1-3 years of experience in licensing, payor enrollment and credentialing preferred.

Physical Requirements

• Prolonged periods of desk work and computer use.
• Ability to lift 15 lbs.