Credentialing Specialist

Responsible for verifying and maintaining the qualifications, licenses, and certifications of healthcare providers, ensuring they meet all necessary regulatory and organizational standards by reviewing and authenticating documents like medical degrees, board certifications, and state licenses, while also monitoring credentialing deadlines and maintaining accurate provider data within compliance guidelines. This person needs to live in Minnesota as this is a hybrid role.  This person will also be the back up front desk person. 

 

Salary:  $55,000 to $60,000 DOE

 

Responsibilities:

Document verification

• Review and verify primary source documents like medical licenses, board certifications, malpractice insurance, and other relevant credentials to ensure accuracy and validity. 

Application processing

• Collect and compile credentialing applications from healthcare providers, including initial applications and re-credentialing requests. 

Data entry and maintenance

• Input provider information into credentialing databases and maintain accurate records of all credentialing activities. 

Compliance monitoring

• Stay updated on regulatory changes and ensure all credentialing practices adhere to federal, state, and payer guidelines. 

Payer submission

• Prepare and submit credentialing applications to insurance payers, including follow-up communication to ensure timely processing. 

Audit and quality review

• Perform periodic audits of credentialing files to identify discrepancies and maintain quality standards. 

Communication and collaboration

• Coordinate with healthcare providers, medical staff offices, and credentialing committees to gather necessary information and resolve any issues. 

Renewal tracking

• Monitor provider credential expiration dates and notifying them of upcoming renewal requirements. 

 

Required Skills:

 

Attention to detail

• Accurately review and verify large amounts of complex medical data. 

Strong organizational skills

• Manage multiple credentialing applications and deadlines effectively. 

Excellent communication

• Clearly communicate with providers, payers, and internal stakeholders. 

Analytical skills

• Identify potential discrepancies or issues within provider credentials. 

Knowledge of healthcare regulations

• Understand federal and state licensing requirements, payer policies, and accreditation standards.

 

 

Education and Experience:

• High school diploma or equivalent required.
• 3-5 years of experience in medical staff credentialing, provider enrollment, or a similar healthcare administrative role.

 

Preferred:

• Associate or bachelor’s degree in healthcare or business administration.
• Certified Provider Credentialing Specialist (CPCS) certification
• Behavioral Health experience.

 

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.

 

Benefits:

MAC offers competitive benefits for all full-time Employees working 30 or more hours each week.

• Excellent PTO benefits
• Paid Holidays
• Medical, dental, and vision with employer contribution
• 401 (k) with employer match
• Employer paid life and disability insurance

 

About our company:

Founded in 1996 by parents who sought the very best treatment available to deliver opportunities to children and adolescents living with autism spectrum disorder (ASD), Minnesota Autism Center (MAC) provides therapeutic services for children ages 18 months to 21 years who have ASD.

MAC's services are center-based and in-home, and include speech and occupational therapy, assessment and diagnosis services, and individual and family therapy. At any given time, MAC serves approximately 370-400 clients throughout Minnesota at 22 centers located in Eagan, Eden Prairie, Maple Grove, Fridley, Vadnais Heights, Minnetonka, Woodbury, Duluth, Superior, Virginia, Mankato, Rochester, Red Wing, New Ulm, Medford, Hutchinson and Cambridge.

MAC is an Equal Opportunity Employer and does not discriminate in terms or conditions of employment on the basis of sex (including pregnancy, childbirth, and related medical conditions), race, traits associated with race (including hair texture and style), color, national origin, religion, creed, age once having reached the age of majority, sexual orientation, gender identity, gender expression, military status, veteran status, disability, marital status, familial status, genetic information, status with respect to public assistance, or any other characteristics that are protected by federal, state or local laws.