Credentialing Specialist

Company: CDR Maguire Inc.
Location: Augusta
Posted on: May 28, 2023

Job Description:

CDR Financial Services seeking for a positive individual that's able to work as a team player. Job responsibilities include but not limited to:

• 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 and according to the schedule published by CMS.
  • Apply for and renew annually all provider licenses (Professional, DEA, Controlled Substances).
  • Complete revalidation requests issued by government payers.
  • 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 with hospitals at which they hold staff privileges.
    • Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
    • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases OTHER PRINCIPAL DUTIES:
      • Other duties that may arise from time-to-time and/or are commensurate with the ti Requirements
        • High school diploma or equivalent preferred
        • Medical billing and coding experience highly required
        • Ability to communicate clearly, work effectively as a team member with physicians and other staff.
        • Sort and file materials correctly by alphabetical or numeric systems
        • Interpret and understand insurance benefits and reimbursements
          • Flexibly respond to changing demands
          • Organize and prioritize tasks effectively
          • Work with little supervision
          • Establish and maintain effective working relationships with patients, employees, and the public Benefits Benefits: Health Insurance, 401K, dental and vision, paid time and vacation hours and paid holidays etc.

Keywords: CDR Maguire Inc., Augusta , Credentialing Specialist, Other , Augusta, Georgia