Healthcare Professional Credentier
4 days ago
About the Position
\This is an exciting opportunity for a skilled provider credentialer to join our team at CoolBlue VA. As a key member of our operations team, you will play a critical role in ensuring the smooth operation of our mental health services.
\Key Responsibilities
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- Manage the full credentialing lifecycle, including initial credentialing, re-credentialing, and privileging.\
- Verify and maintain provider qualifications, licenses, malpractice insurance, and continuing education records.\
- Coordinate with providers to collect and submit necessary documentation to insurance companies and credentialing organizations.\
- Work with insurance companies and CAQH to ensure provider enrollment and network participation.\
- Ensure compliance with HIPAA, Medicare, NCQA, URAC, and Florida mental health regulations.\
- Track expiration dates for licenses and initiate re-credentialing.\
- Resolve credentialing issues to prevent billing disruptions.\
- Qualifications:\
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- HIPAA Certified with 2-5 years of mental health provider credentialing experience.\
- Strong knowledge of payer-specific requirements and mental health credentials (LCSW, LPC, LMFT, PhD/PsyD, etc.).\
- Familiarity with insurance panels (Aetna, BCBS, Cigna, Humana, Tricare, UnitedHealthcare).\
- Proficiency in credentialing software, Microsoft Office, and provider databases.\
- Excellent organizational and communication skills.\
- Must have a work-from-home setup.\
- \
- Certified Provider Credentialing Specialist (CPCS) or similar certification.\
- Experience in a mental health group practice.\
- We're looking for a proactive, detail-oriented professional who can work with minimal supervision.\
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- Our Requirements
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