Credentialing Specialist

Keplr Vision has an immediate for a professional Credentialing Specialist in our Field Ops department. (REMOTE)

Summary/Objective

The credentialing specialist develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes and patient satisfaction. The Credentialing Specialist is responsible for provider enrollment and credentialing with all payers. Primarily, the Credentialing Specialist will be responsible for each application from initiation to approval and ongoing maintenance of provider enrollment and credentialing.

Primary Function

• Ongoing, professional, and effective touchpoints with all active providers
• Provide high level of customer service
• Ensure accurate ongoing collection of key provider data element updates and changes
• Performs updates to the provider database on a regular basis to ensure compliancy
• Responsible for provider contract administration to ensure that all contract providers have a current and valid contract on file with all participating health plans
• Supporting providers through the credentialing/re-credentialing process, including addressing provider questions, and ensuring timely completion of applications
• Responsible to develop relationships with all Health Plans
• Coordinates and ensures all necessary logistics obtained to support a successful implementation (contracts, EMR access, onsite access, etc.)
• Ensures provider compliance with all state and federal programs
• Proactive identification and resolution of plan gaps within a practice
• Other credentialing, support and compliance duties as assigned

Minimum Qualifications/Requirements

• 2 - 3 years administrative experience in the healthcare field preferred
• At least 2 years in Provider Enrollment
• Minimum High School diploma or GED
• Highly organized with attention to detail
• Ability to effectively prioritize multiple tasks and deadlines, with flexibility and capacity to identify and administer competing operational priorities in a changing environment with creativity and resourcefulness
• Excellent verbal, interpersonal, judgment and problem-solving abilities
• Ability to undertake assignments with minimum supervision and direction

Equal Opportunity Employer