Credentialing Specialist

🕒 June 25

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BerryDunn — Assurance, Tax and Consulting

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1974

🏥 Healthcare

🛡️ Insurance

⚖️ Legal

Healthcare • Insurance • Legal

BerryDunn is an award-winning accounting and consulting firm with a 50-year history dedicated to providing exceptional services in assurance, tax, and consulting. The firm focuses on forming close partnerships with clients to deliver customized solutions that drive meaningful outcomes. Its expert teams work across various sectors, helping public and private entities optimize finances, reduce risks, and improve business processes with a commitment to client success.

📋 Description

• Complete credentialing and/or re-credentialing applications for physicians, ancillary providers and facilities or groups with third-party payers and governmental programs (Medicare and Medicaid) as requested by the client in an accurate and timely manner • Perform Primary Source Verification (PSV) services including but not limited to verification of licenses, malpractice and work history; perform PSV file audits as requested. • Complete, update and maintain Council for Affordable Quality Healthcare (“CAQH”) profiles for providers • Maintain a Credentialing database in accordance with BerryDunn’s policies and procedures for all participating and non-participating providers with payer identification numbers and effective dates • Partner with client liaisons, including billing departments to update the enrollment status of the providers • Contact payers to follow up on submitted applications within BerryDunn’s policies • Respond to various inquiries and requests for information from participating physicians, staff, hospitals, and managed care companies timely and with professionalism • Communicate with providers or their designees to obtain requisite credentialing information to facilitate timely completion and submission of required documents • Update client regularly on process and communicate any delays • Continuously inform Credentialing leadership of the project status and assist in managing expectations related to deliverables and deadlines • Be responsible for timely and accurately accounting of hours (billable and non-billable) in time and attendance software for proper billing of services rendered

🎯 Requirements

• High school education required, bachelor’s degree preferred • 2-3 years of relevant healthcare experience is required including specialized skills in Credentialing and/or Medical Billing • Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Service Management (CPMSM) certification a plus • Ability to work independently, as well as, in a team setting • Exceptional organization and time management skills to manage priorities and deadlines • Effective verbal, interpersonal, and written skills • Strong attention to detail and quality • Proficiency with Microsoft Office suite (Word, Outlook, Teams) and Adobe; Excel preferred

🏖️ Benefits

• Access to benefits that support physical, mental, career, social, and financial well-being