Credentialing Specialist – Coordinator

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $26 - $28 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Family Health Center of Worcester, Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Family Health Center of Worcester, Inc. is a full-service health center dedicated to providing comprehensive health care services, including primary care, dental care, and behavioral health, to all residents of the greater Worcester area, regardless of their ability to pay. The center emphasizes access to affordable, high-quality, and integrated healthcare, with a particular focus on culturally diverse populations. In addition to health services, FHCW offers patient support programs and educational opportunities through partnerships with academic institutions.

📋 Description

• Support providers through the privileging and credentialing process at acceptance of employment • Initiate hospital credentialing for physicians and collaborate with UMass to maintain physician hospital appointments • Maintain internal provider IDs, rosters, provider information, and NPI/PECOS access • Support providers with applying for and renewing professional, DEA, controlled substance, and other required practice licenses and documentation • Perform primary source verifications required by CMS, HRSA, Joint Commission, and NCQA • Facilitate compliance trainings, CME's, and Life Support Trainings • Re-credential providers for the Health Center and UMass • Maintain accurate provider credentialing profiles in Cactus Cred software • Track and report monthly on credentialing expirables • Complete MassHealth and PECOS revalidation requests • Complete credentialing applications for commercial payers, Medicare, and Medicaid • Track and report provider enrollment progress • Initiate and maintain provider CAQH database files according to CMS schedules • Complete re-credentialing applications for commercial payers • Collaborate with the Revenue Cycle Director and billing staff to resolve credentialing-related denials and authorization issues • Create and maintain provider profiles in CAQH, PECOS, NPPES, MassHealth/C3, and CMS databases • Perform other duties as assigned

🎯 Requirements

• High school diploma, GED, associate degree, or bachelor's degree • 2 years of credentialing experience preferred • 2 years of experience in a medical practice business office role required • Knowledge of provider credentialing and provider enrollment and their impact on the practice's revenue cycle • Excellent computer skills, including Excel, Word, and Internet navigation for state and federal sites and health-plan searches • Detail-oriented with strong organizational and time-management skills • Ability to plan and prioritize to meet deadlines • Excellent customer service skills • Clear, effective, and professional communication

🏖️ Benefits

• Facilitate/support providers in obtaining compliance trainings, CME's, and Life Support Trainings when due