This is an opportunity to join an incredible team here at PPS.  We have been in this business for over 12 years so if stability is important to you then we are your place.  We need 1-3 organized, honest, detail-oriented Insurance Credentialing Specialists to join our team. We have team members throughout the country so location is not important as long as you’re in the lower 48.  You will have the support you need while also having the freedom you deserve.

Summary of position: Responsible for managing the daily credentialing process for medical practices and facilities across the US as assigned.

Job Duties

  • Facilitate the hospital privileging process.
  • Identify issues that require additional investigation and evaluation, validates discrepancies, and ensure appropriate follow up.
  • Monitor the initial, reappointment and expiry process for all Allied Health Professional staff and delegate providers, ensure compliance with regulatory bodies, as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
  • Responsible for tracking application process until approval has been granted at each facility and provides written report to appropriate departments.
  • Completes CAQH applications as needed.
  • Maintains up-to-date data for each provider in the databases and online systems.
  • Ensure timely renewal of all licenses and certifications.
  • Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
  • Maintain knowledge of current health plan requirements for credentialing providers.
  • Respond to inquiries from other healthcare organizations.

Job requirements

  • Comprehensive knowledge of credentialing process on both the facility and insurance enrollment side
  • Computer literate as you will be required to utilize multiple web based systems on a daily basis.  These include, excel, google, email etc.
  • Ability to interface with people using tact and diplomacy.
  • Excellent written and oral communication skills.
  • Excellent organization and detail-oriented skills.
  • Excellent problem-solving skills.
  • Ability to coordinate and prioritize multiple tasks in a fast-paced environment.
  • Capability to work within timeframes and under pressure
  • Outstanding professional demeanor
  • Must be well organized and detail oriented.
Additional Requirements
  • Honest
  • Reliable
  • Positive attitude 
  • Fast internet
  • Quiet place to work on a daily basis
Helpful but not required:
  • Billing experience which could include coding, claims process, denials management
  • Experience with AdvancedMD, eCW or AthenaHealth
  • Eligibility and EDI enrollment experience
  • Insurance Contract negotiation experience
  • Medical licensing for medical providers

Physical Demands:

Sitting at computer for extended periods of time.  Working under stress(although we try to limit this) and use of telephone/computer as required. Manual dexterity required for use of calculator and computer keyboard. While performing the duties of this job, the employee is regularly required to talk or hear and take detailed notes while on the phone.

Other Details:

This is a full-time position but we do have some part-time and consulting opportunities available if desired.  Pay is competitive and determined based on experience

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