About this role
Credentialing Specialist
Cumberland Family Medical Center (CFMC) operates a Federally Qualified Health Center (FQHC) offering a wide range of health and social services at multiple sites throughout Kentucky. We seek employees who support our mission and who actively contribute to our service-driven environment by enhancing patient experience and improving productivity. CFMC offers compassionate care, uncompromising service and clinical excellence. We offer a collaborative environment with excellent benefits, wage/salary commensurate with experience and relevant work experience.
Duties and Responsibilities:
- Enrolls physicians with contracted payers and maintains current and organized records of all credentialing information to include completing applications, obtaining signatures, providing necessary documents to complete the credentialing process.
- Maintains provide listings with Medicare, Medicaid, and other carriers.
- Performs initial contact with contracted payers to initiate credentialing process and enable a relationship with the provider and network representatives.
- Maintain and update accurate reports regarding provider participation.
- Responsible for setting up and maintaining provider and group records.
- Maintains credential database in accordance with time standards.
- Reviews credentialing applications for completeness and accuracy of documentation according to specified standards for submission to insurance carriers for credentialing.
- Communicates and tracks applications with payers to ensure timely and accurate credentialing of providers.
- Review records for completeness, accuracy and compliance with regulations.
- Maintain and update accurate reports regarding provider participation.
- Other duties as assigned.
Qualifications
Education/Experience:
- High school diploma/GED.
- A minimum of 2 years related experience in credentialing or equivalent combination of education and experience.
- Must have good communication skills.
- Proficient in MS Outlook; MS Excel and MS Word.
Schedule Requirements:
Full-time position, 5 days per week, 100% office-based, in person work required.
Work schedules are set at the discretion of CFMC and may be adjusted at any time based on the operational needs of the organization.
Compensation : Negotiable based on experience
Benefits : Health, Vision, Dental, Life, STD, LTD, 401K, PTO, and Holidays