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Cynet Systems · 3 months ago

Provider Credentialing Specialist - Remote / Telecommute

United States

Full-time

Remote

Mid Level

$22.14/hr - $27.14/hr

3+ years exp

Cynet Systems is a company seeking a Provider Credentialing Specialist to manage credentialing applications and ensure compliance with state laws and corporate procedures. The role involves analyzing applications, maintaining provider files, and responding to inquiries regarding provider participation and credentialing status.

EmploymentRecruitingStaffing Agency

Growth Opportunities

Responsibilities

Analyze credentialing applications and perform primary source verification of credentials

Determine appropriate network participation and obtain executed contracts to formalize provider relationships

Respond to internal and external inquiries regarding provider participation, credentialing, and status updates

Maintain provider files and update MDStaff and electronic records for credentialing, recredentialing, demographic updates, and terminations

Identify, analyze, and resolve provider file issues, ensuring data integrity and proper system integration

Prepare written requests and follow up with providers to obtain missing information

Ensure compliance with state laws, departmental guidelines, and corporate procedures

Qualification

Physician credentialing experienceExcel proficiencyMedical terminology knowledgeCPCS certificationReasoning abilityVerbal communication skillsWritten communication skillsInterpersonal skillsAttention to detail

Required

Minimum 3 years of experience in physician credentialing or health insurance/managed care operations (customer service, claims, billing, enrollment, or call center environment)

Proficiency in Excel, including pivot tables

Excellent verbal and written communication and interpersonal skills

Knowledge of medical terminology

Ability to interpret jurisdictional requirements and apply reasoning to verification processes

Strong attention to detail and adherence to standard operating procedures

High School Diploma required