Credentialing Specialist/Coordinator
$54,080–$58,240 year
RemoteMassachusetts, United States
Job Summary
Initiate and maintain provider privileging and credentialing for physicians, ensuring accurate profiles in Cactus, CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases. Perform primary source verifications for initial and re-appointment cycles, manage license renewals, and coordinate hospital appointments with UMass. Track monthly expirables, complete revalidation requests for Medicare, Medicaid, and commercial payers, and resolve authorization denials with revenue cycle staff. Maintain compliance training records and CAQH database files per CMS schedules. This part-time, remote role requires 20 hours weekly and is based in Massachusetts.
Required Qualifications
- 2 years experience in a medical practice business office role
- High School Diploma, GED, Associates /Bachelors degree
- Excellent computer skills including Excel, Word, and Internet navigation for State, Federal sites and healthplan searches
- Detail oriented with above average organizational skills, and time management
- Plans and prioritizes to meet deadlines
- Excellent customer service skills
- Communicates clearly, effectively and professionally
- Knowledge of provider Credentialing & Provider Enrollment and its direct impact on the practice's revenue cycle
Desired Qualifications
- 2 years credentialing experience preferred
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