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
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