Credentialing Specialist

Nautical Staffing is looking for (1) full-time and (1) part-time Credentialing Specialist for our US-based client in the physical therapy industry.

The Credentialing Specialists are responsible for ensuring that the facilities in which they work and represent are fully compliant with all state and federal regulations at all times. They must also ensure that every staff member is legally licensed and/or credentialed and up to date with the latest medical policies and procedures.

Responsibilities:
• Create and maintain licensing, credentials, and insurance records
• Conduct research on updated state and federal regulations and policies
• Help develop internal credentialing processes
• Monitor license and credential expiration dates and advise staff members of required “renew by” dates
• Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions
• Maintaining active status for all providers, and ensuring all providers are properly credentialed with all payers
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain an internal provider grid to ensure all information is accurate and logins are available.
• Maintain accurate and up to date provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Complete credentialing, re-credentialing, and privileging applications to add providers to commercial payers, Medicare, and Medicaid.
• Work closely with the Director of Revenue Cycle and billing company staff to identify and resolve any denials or authorization issues.
• Provide administrative support required to ensure effective management and coordination with clients
• Performs other related work as required or requested.

Qualifications:
• Prior experience in credentialing is required
• Background in the physical therapy industry is preferred, not required
• Must be proficient in CredentialMyDoc (HealthStream) or other credentialing software
• Must be willing to work either full-time or part-time during US Pacific business hours

Instructions:
• Send a link to your updated CV (add it to the body of your message)
• Write 1 paragraph about your credentialing experience
• Indicate if you prefer full-time or part-time
• Use “Polaris – Credentialing” as the subject