Provider Credentialing Specialist

Crossroads Treatment Centers Greenville , SC 29601

Posted 5 months ago

Provider Credentialing Specialist

Crossroads Treatment Centers is one of the largest and fastest growing providers of outpatient Opioid Treatment Services. With nationally accredited outpatient centers across the country, our specialized treatment program has been helping people suffering from opioid addiction for over 10 years.

We are currently seeking a Provider Credential Specialist with Medicaid experience to join our growing team. The ideal candidate must have a minimum of three-five years experience in credentialing of providers for Medicaid and commercial insurance as well as managed care Medicare a plus. This position will be supporting the Network Management Director.

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Requirements

  • Assist and resolve contractual denials with payors
  • Familiar with E/M & CPT Behavioral Health coding
  • Experience with facility and individual provider credentialing
  • Experience developing policies and procedures
  • Provider Relations experience
  • Assist with contractual denials with payors
  • Administrative duties as assigned
  • Highly organized, self-starter, and self-motivated professional
  • Experience in credentialing of providers for Medicaid and commercial insurance
  • Reviews existing departmental policies and procedures annually and works with management to make updates as needed
  • Complete and Assist provider credentialing applications; monitors applications and follows-up as needed.
  • Maintains corporate provider contract files.
  • Perform outreach to providers and facilities via phone calls and fax/email correspondence.
  • Responsible for maintaining the good standing of all applicable licenses.

Qualifications

  • Ability and desire to embrace change, while maintaining a high level of productivity
  • Multi state experience
  • A commitment to excellence, strong interpersonal, oral and written communication skills required
  • Critical thinking, detail oriented and strong organizational skills required
  • Excellent interpersonal, oral and written communication skills required
  • Critical thinking, detail oriented and strong organizational skills required
  • Bachelor's degree preferred/High school diploma required
  • Proficient in Microsoft Office, including Word, Excel, and Outlook
  • 3+ years of experience within a managed care department with specific expertise in credentialing and/or licensing
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Provider Credentialing Specialist

Crossroads Treatment Centers