Credentialing/Insurance Contracting Specialist

Summary

Join Neolytix, a boutique consulting firm, as a Credentialing and Insurance Contracting Specialist! You will maintain provider and group active status with insurance plans by completing credentialing and contracting applications. This role requires managing provider files, internal trackers, and CAQH database updates. You will also handle revalidation requests, coordinate with clients and staff, and maintain accurate provider profiles across various databases. Neolytix offers excellent benefits, including complimentary medical coverage, a retirement savings plan, and life & disability insurance. Enjoy a collaborative work environment and opportunities for professional growth.

Requirements

• Knowledge of provider credentialing and contracting with government and commercial Insurance plans at least in one state in USA
• Minimum 1 year of experience in submitting applications for contracting and credentialing with Insurance plans
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively

Responsibilities

• Maintain individual provider files and group information to include up to date information needed to complete the required government and commercial payer credentialing applications
• Maintain internal trackers to ensure all information is accurate and logins are available and legible
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Complete revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers
• Credential new providers and re-credential current providers
• Credential/ approve new and existing groups with government and commercial insurance plans
• Coordinate with client and doctors and billing staff to identify and resolve any missing items, signatures, expiration of license or any other issues related to provider credentialing
• Keep the clients updated on the progress of their application and scope of work
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Other duties as assigned

Benefits

• Complimentary Medical Coverage for your Family & dependents
• Retirements Savings Plan
• Life & Disability Insurance