Covenant Family Solutions is seeking a Full-Time Credentialing, Licensing, and Contract Specialist to join our administrative team. If you are looking to be part of an amazing company that is passionate about making a difference in individuals’ lives, then Covenant is the place for you.
The Credentialing Specialist helps ensure that providers maintain current credentials and licenses to work legally in their field or specialty. The specialist monitors upcoming license renewal dates and works with providers to advise them of the required steps to maintain their credentials. They also review required licensures and certifications for potential new employees to ensure all are current before hiring.
In addition, the specialist also negotiates contracted rates with insurance companies to increase reimbursement rates for providers. The credentialing specialist is informed about the regulations and standards required for providers to achieve and maintain licensure and other credentials.
This role is best suited for someone who enjoys working independently. The specialist needs to be able to manage workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements. Frequent interaction with insurance companies and providers is expected.
- Maintain compliance with all regulatory and accrediting institutions.
- Monitor staff credentials and licenses.
- Advise staff on renewal procedures.
- Participate in the development of internal credentialing processes.
- Keep records of provider licenses, credentials and insurance contracts.
- Release information to agencies and members of the public as required by law.
- Negotiate reimbursement rates with insurance companies.
Education and Qualifications:
- Experience with insurance companies and credentialing is required.
- An associates degree or higher is preferred.