Credentialing Specialist

Description Join us at Dermatology Partners, where your career flourishes alongside your health and happiness. Your future starts here-let's grow together! Discover the Benefits of Joining Dermatology Partners! No Nights or Weekends Growth Opportunity Medical, Dental, and Vision Insurance PTO & Paid Holiday’s 401 (k) with 4% employee match-Fully Vested Company paid Life Insurance Options of additional Life insurance, Short & Long term disability, Critical Illness and Accident Insurance Employee Discount Referral Bonus Employee Appreciation Day: Dorney Park in Fall Employee Assistance Program (EAP)

Dermatology Partners is a Dermatology group with locations in Pennsylvania, Delaware, and Maryland. Our Core values are the foundation for everything we do as an organization. Our Core Values are: Grow Together Seize Opportunity from Struggle Outcome Over Ego Commitment to Serve Do The Right Thing

• The Credentialing Specialist position is responsible for ensuring that healthcare providers are properly credentialed and in compliance with all regulatory and organizational standards.
• This role involves verifying the credentials, licensures, certifications, and background of medical professionals to maintain compliance with industry standards and legal regulations.
• Responsibilities include: Credential newly hired clinicians with applicable insurance payers for timely billing.
• Collect, Submit, & Track all necessary documentation.
• Process re-credentialing for existing clinicians as required by individual payers.
• Maintain a current, accurate database of all clinicians’ credentialing / licensure status, needs, expirations, issues, etc.
• Share with internal staff as applicable.
• Communicate & Coordinate with all levels of internal staff & external stakeholders to ensure timely & consistent qualification is met & maintained.
• Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.
• Investigate and resolve any issues that arise during the approval process.
• Under the direction of leadership, assist with site level enrollments or changes to contract.
• Other duties as deemed necessary.

Requirements

2+ years working in health plan enrollment is preferred High attention to detail including effective communications at all organizational levels Experience credentialing across multiple states as well as across Commercial and Medicaid payors Experience with state Medicaid enrollment is preferred Experience working in a team environment Demonstrated organizational skills and ability to adhere to timelines Preferred but not necessary: Familiarity or experience with provider enrollment or medical licensing Startup experience