Job Description

Terms of Employment

• Contract-to-Hire, 6 Months
• Location: Hybrid Schedule (Candidates should reside in MD, DC, and VA only)

Overview
Our client is looking for three (3) Credentialing Specialists to join the team to help support the credentialing of the new practitioners for network participation within the client's Behavioral Health Network. The specialist must verify that the provider can participate in the program and accurately maintain all provider data within the enterprise-wide Provider file according to Industry Standards.

• The Specialist will receive provider applications that they will work from start to finish. There are twelve (12) primary source verification to complete in the credentialing file, once completed, they will take this data and enter it into the EVIP system. After the data is added to the EVIP system they will be required to complete a spreadsheet that is added to the downstream systems to claims department for approval ensuring a successful integration with the other corporate systems (most verifications are completed within 30 days, due to certain documents that may expire).
• Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status, credentialing, contractual status and provider file updates. Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved. Professional etiquette, communications and sound decision making is required.
• Maintains the provider file, the Provider Information and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
• Responsible for identifying, analyzing and resolving immediate and existing provider file issues. Processes provider file inputs in accordance with applicable state laws and departmental guidelines.
• Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.

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