Credentialing Specialist

The Credentialing Specialist reports to the Director of Payor Enrollment, Licensing & Credentialing and is responsible for supporting all aspects of the medical licensing and credentialing processes. The Credentialing Specialist will ensure the efficient operation of medical licensing, credentialing, and payer contracts to maximize provider efficiency.

Responsibilities

Credential/Re-credential LifeMD providers with insurance payors and/or hospitals; Maintain and update insurance credentialing and the CAQH Provider System; Maintain credentialing matrices for all LifeMD providers and markets/states; Provide follow-up correspondence with insurance payors on a regular basis for all credentialing matters; Work with other LifeMD departments to facilitate the onboarding/offboarding of LifeMD providers; Assist LifeMD providers with any ancillary credentialing, licensing or payor enrollment questions; Obtain necessary licensure and/or privileges for LifeMD providers; Create, maintain and update provider credentialing rosters for LifeMD; Performs external research and conducts verification of all LifeMD licensure, malpractice and educational degrees, diplomas and certifications; Checks insurance payor websites for accurate directory listings and performs regular updates; Meet LifeMD expectations for payor application submission on a consistent basis; Performs complex and confidential administrative functions including developing and typing written correspondence; Responds to routine external correspondence; Types memos, and other department forms and documents; Handles confidential and non-routine information and maintains provider confidence and protects operations by keeping all provider and LifeMD practice information confidential; Work independently and within a team on special and nonrecurring and ongoing projects at the request of the Director of Payor Enrollment, Licensing & Credentialing, which may include updating Excel spreadsheets or other systems, and disseminating information; Reliability- it is an essential function of this position to report to work on time for your scheduled hours, ready for work; Perform other related duties as required

Requirements

Credentialing Certification, Bachelor’s Degree in Business Administration/Healthcare Administration or equivalent experience; 2+ years of relatable experience performing credentialing and administrative functions; Certified Provider Credentialing Specialist (CPCS), Certified Medical Services Management (CPMSM) or CPES (Certified Provider Enrollment Specialist); Expertise in credentialing, (multi-state) licensing and (multi-state) payor enrollment functions and processes; Excellent analytical skills with the ability to interpret and act on complex data; Key to have knowledge of healthcare regulations and compliance requirements; Proficiency and ability to adapt to new credentialing software; High level of proven communication skills, including written, verbal and conceptual presentation; Ability to work in a fast-paced, dynamic growth environment; Creative problem solver, strategic thinker and team player who thrives in a collaborative environment; Fantastic organizational and time management skills with high attention to detail

Benefits

Health Care Plan (Medical, Dental & Vision); Retirement Plan (401k, Roth 401k); Life Insurance (Basic, Voluntary & AD&D); Flexible Paid Time Off; Paid Holidays; Short Term Disability; Training & Development