Medical Staff Credentialing Specialist, Sr. jobs in Tuscaloosa, AL

POSITION TITLE:  Medical Credentialing Clerk

Busy medical practice in Tuscaloosa is seeking a Medical Credentialing Clerk to provide credentialing, recredentialing, and revalidation for all providers through various insurance payors. Completes and submits all credentialing applications. Maintains current information in all external databases.

QUALIFICATIONS:

• Associate degree or certification in related field preferred.
• 2 years of credentialing experience preferred.
• Experience with insurance processing (filing insurance claims and working denials, appeals, rejections).
• Must be proficient with medical terminology.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Ability to handle multiple tasks simultaneously. Must have good organizational skills and strong attention to detail.
• Ability to apply independent judgment and complete all tasks accurately.
• Highly proficient with computer applications, including Microsoft Office (Word, Excel, etc.).
• Healthcare experience, billing and regulations related to Medicare, Medicaid, and commercial insurance knowledge, helpful.

SUMMARY OF DUTIES:

• Collect and assemble all pertinent information for preparation of applications, such as CVs, licenses, board certifications, provider demographics, educational verification, DEA certificates, etc.
• Keep detailed records of medical staff members, maintain databases, and ensure staff members possess legal licenses and credentials.
• Maintain accurate and up-to-date provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Complete and submit accurate credentialing, and recredentialing applications to commercial payers, Medicare, and Medicaid in a timely manner.
• Work closely with the Director and billing staff to identify and resolve any denials or authorization issues.
• Process medical billing claims and other billing duties as assigned.