Credentialing Specialist/Coordinator

About the role

This position is remote and part-time at 20 hours per week. The Credentialing Specialist/Coordinator maintains active status for all providers by completing initial and subsequent re-appointment and re-credentialing packages required by the Health Center, admitting hospital (UMass), commercial payers, Medicare, and Medicaid.

Responsibilities

• Provider Onboarding (Privileging/Credentialing):
  • Initial contact and support for providers during the privileging and credentialing process upon employment acceptance.
  • Initiate provider hospital credentialing for physicians and collaborate with UMass to maintain physician hospital appointments.
  • Maintain an internal provider ID roster to ensure accuracy of provider information and availability of logins (NPI/PECOS access).
  • Support providers in applying for and renewing licenses, including professional, DEA, controlled substance, and other required documentation.
• Perform all Primary Source Verifications as required by CMS/HRSA/Joint Commission/NCQA for all healthcare professionals at initial and re-appointments.
• Facilitate and support providers in signing up for and obtaining compliance trainings, CMEs, and life support trainings when due.
• Re-credential providers as required for both the Health Center and UMass Board-Provider List Board Letters.
• Credentialing Compliance:
  • Maintain accurate provider credentialing profiles in Cactus Cred software.
  • Track and report monthly on all credentialing expirations.
• Provider Health Plan Enrollment (Revenue Cycle):
  • Complete revalidation requests issued by MassHealth and PECOS for all providers.
  • Complete credentialing applications to enroll providers with commercial payers, Medicare, and Medicaid.
  • Track and report provider enrollment progress.
  • Initiate and maintain each provider’s CAQH database file according to the CMS schedule.
  • Complete re-credentialing applications for commercial payers.
  • Work closely with the Revenue Cycle Director and billing staff to resolve denials or authorization issues related to provider credentialing.
  • Create and maintain accurate provider profiles in CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases.
• Other duties as assigned.

Requirements

• High School Diploma, GED, Associate’s, or Bachelor’s degree.
• 2 years of credentialing experience preferred.
• 2 years of experience in a medical practice business office role required.

Skills

• Knowledge of provider credentialing and provider enrollment and its impact on the practice’s revenue cycle.
• Excellent computer skills, including proficiency in Excel, Word, and internet navigation for state, federal sites, and health plan searches.
• Detail-oriented with strong organizational and time management skills.
• Ability to plan and prioritize to meet deadlines.
• Excellent customer service skills; communicates clearly, effectively, and professionally.

Schedule

Part-time, 20 hours per week.