Credential Specialist

Company Description

Ambit Global Solution LLP is a leading provider of medical and dental billing and revenue cycle management services. The company offers comprehensive solutions to healthcare organizations, including hospitals, dental groups, and private practices, aiming to maximize revenue and reduce operating costs. With a team of dedicated professionals, including AAPC-certified coders, Ambit leverages cutting-edge technology and a client-centric approach to deliver efficient and transparent services across various specialties.

Job Title:

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Experience Required:

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Summary:

The Provider Credentialing Specialist supports the Credentialing Department by managing and maintaining accurate, up-to-date provider data to include updates, changes, additions, and terminations in the credentialing, while working under timeline, accuracy, and production targets. Performs credentialing activities including primary source verifications, communicating with Providers to request missing information supporting the integrity of Provider data in all downstream systems, and key-entering initial data of potential network Providers into the credentialing system.

Key Responsibilities:

•Manage and facilitate provider Enrollment and credentialing for healthcare professionals and facilities using the Cactus credentialing system.

•Process Provider credentialing inventory within expected timeline, accuracy, and production targets.

•Update outdated provider credentialing and demographic information.

•Reviews Provider applications and verifies that each meets all credentialing criteria.

• Review provider applications for accuracy and completeness, follow up to obtain missing information materials on time, and follow department standards.

•Queries primary sources, as applicable, to verify Provider credentials and qualifications.

•Prepares files for review by the Credentialing Committee.

•Maintains current credentialing, and directory status information in a Provider credentialing system (Provider database).

•Represents the Credentialing Unit at Credentialing Committee meetings as needed.

•Achieves and maintains required department credentialing timeframe standards.

•Communicates professionally and concisely through both written and verbal communication and can share information and instructions for updating and correcting Provider credentialing databases.

•Coordinate with internal departments for Provider database-related issues.

•Works with Credentialing Verification Organization(s) as directed.

•Performs other duties as assigned.

•Regular and reliable attendance is required.

Preferred:

•Coordinate with internal departments for Provider database-related issues.

•5+ years of credentialing experience

•Experience using provider credentialing software systems or Provider Data Management Systems

•Knowledge of URAC or NCQA standards.