Credentialing Specialist


RCO - Plano, TX

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Location:

Plano Corporate Office



Overview:

Purpose:  

Responsible for the timely credentialing, and  re-credentialing for all providers who provide patient care.   Maintains up-to-date data for each provider in Verity. Provides regular outreach to offices for claims inquiries and follows up to ensure timely resolution of office inquiries and certifications are up to date (license, DEA, BLS, CDS, NPI). Provides weekly reports with status changes regarding payor status and or credentialing to all Vice President of Operations, District Manager of Operations, and Recruiting.


Responsibilities:

  • Compiles information and sets up provider files in Verity Credentialing system. Maintains Verity credentialing software to ensure information is accurate and up-to-date.
  • Completes initial provider credentialing applications; monitors applications and follows up as needed, notifies offices and Regional directors of completed applications.
  • Tracks expiration dates and maintains current state licenses, DEA certificates, malpractice coverage and any other required documents for all providers.
  • Track all expired provider certifications.
  • Completes, re-credentialing applications as requested by insurance companies.
  • Works closely with Recruiting, HR and Dentists to obtain all necessary credentialing information and certificates

Qualifications:

 

Experience/Skills/Abilities:

  • Maintains confidentiality of provider information.
  • Provides regular credentialing status updates to offices, regional directors and leadership
  • Ability to meet strict deadlines and to work with minimal supervision
  • Communicates professionally with all staff, and keeps manager and regional directors informed of missing or incomplete information.
  • Performs other duties as assigned.

Work environment/Conditions:

  • Overtime as needed to perform job duties
  • Travel 10% as needed