Credentialing Specialist

The Credentialing Specialist is a critical company role of which is responsible for credentialing and re-credentialing applications and/or enrollments of the agency and its providers with insurance carriers and other third party payers. The primary responsibility of this role is to ensure Directions for Living and it's providers are credentialed in a timely manner with all appropriate funders. Primary duties include attaining and maintaining the organization's "in network" status with various funders, communicating credentialing status with internal and external stakeholders, updating provider credentials within EHR system, keeping up to date on all credentialing requirements, tracking expirations and renewals of all credentialing contracts and communicating when renewals are due, following up on credentialing related approvals and rejections with insurance carriers, and acting as the liaison between the agency and its funders.

SPECIAL KNOWLEDGE AND SKILLS:

1. Minimum of 2-years credentialing experience required.
2. Minimum of 1 year of direct experience with Medicare, Medicaid, HMO and Third Party billing and remittance processes, preferably in mental health;
3. Preference given to those with experience working in a community based service setting.
4. Experience with medical or clinical billing software.
5. Robust understanding of the provider enrollment and the credentialing process.
6. Strong knowledge of Florida Medicaid, Medicare Part B, and third party programs in regard to billing, claim submissions, claims appeals, remittances, coding guidelines, statutes, rules and regulations.
7. General office practices and procedures.
8. Alpha and numeric filing systems.
9. CPT, HCPCS and ICD-9/10CM coding terminology and usage and documentation requirements.

Current Openings for Credentialing Specialist Jobs at Directions for Living

Job Title	Department	Location	Closing Date	Employment Type

Get Notified of New Jobs at Directions for Living