Credentialing Specialist/Coordinator

Credentialing Specialist/CoordinatorThis position is remote and part-time 20 hours per week and must reside in Massachusetts.The Credentialing Specialist/Coordinator is responsible for maintaining active status for all providers by successfully completing initial and subsequent Re?Appointment and Re?Credentialing packages as required by the Health Center and for our admitting hospital (UMass), our commercial payers, Medicare and Medicaid.Responsibilities:Provider OnBoarding (Privileging/Credentialing)Initial Contact/Support to Provider's with Privileging & Credentialing process at acceptance of employmentInitiate Provider Hospital Credentialing for Physicians, collaborate w/UMass to maintain Physician Hospital AppointmentsMaintain internal provider ID''s roster to ensure all information for Provider's is accurate and logins is available (NPI/PECOS access)Complete/Provide support to providers in Applying for and renewing provider licenses; Professional, DEA, Controlled Substance, and any other required supporting documentation to practice medicine.Perform all Primary Source Verifications as required by CMS/HRSA/Joint Commission/NCQA for all Health Care Professionals at initial and Re?Appointments of all LIP's.Facilitate/Support providers in signing up and/or obtaining compliance trainings, CME's, Life Support Trainings when dueRe?Credential providers as required for both the Health Center and for UMassBoard?Provider ListBoard LettersCredentialing Compliance:Maintain accurate provider credentialing profiles in (Cactus) Cred software.Track and Report Monthly on all Credentialing ExpirablesProvider Health Plan Enrollment (Revenue Cycle):Complete revalidation requests issued by both MassHealth and PECOS for all providers.Complete credentialing applications to enroll providers to commercial payers, Medicare, and MedicaidTrack/Report Provider enrollment progressInitiate and Maintain each provider's CAQH database file timely and according to the schedule published by CMSComplete re?credentialing applications for commercial payersWork closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialingCreate/Maintain accurate provider profiles on online profiles in CAQH, PECOS, NPPES, MassHealth/C3 and CMS databasesOther duties as assignedKnowledge, Skills and Abilities:Knowledge of provider Credentialing & Provider Enrollment and its direct impact on the practice's revenue cycleExcellent computer skills including Excel, Word, and Internet navigation for State, Federal sites and healthplan searchesDetail oriented with above average organizational skills, and time managementPlans and prioritizes to meet deadlinesExcellent customer service skills; communicates clearly, effectively and professionallyEducation and Experience:High School Diploma, GED, Associates /Bachelors degree2 years credentialing experience preferred2 years experience in a medical practice business office role requiredMonday-Friday, hours and schedule to be discussed with the hiring manager.