Position Description

Credential Representative - (St. Louis, MO)
Location US - MO - St. Louis
Requisition ID 6419
# of Openings 1
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Why not work somewhere better? The road to better starts with a single step. Join us on our relentless quest to improve the lives of those who practice medicine and those they care for. Our goal? Healthier patients, happier providers and happier employees. Please visit our website at: www.nextgen.com.

Credentialing Representative – (St. Louis, MO)

Job Summary:

Responsible for providing support to our groups and practitioners being credentialed in order to make the credentialing process run smoothly. Responsible for all aspects of the credentialing and re-credentialing process. Compile, validate and review professional qualifications of a practitioner or practice in their field meeting specific company requirements. Responsible for ensuring practitioners are credentialed with health plans and maintaining up-to-date data for each practitioner in credentialing databases and online systems.

Job Responsibilities:

  • Acts as liaison between the practitioners, health plans, billing floor and all related entities regarding credentialing, malpractice coverage and practitioner enrollment.
  • Compiles, maintains and audits current and accurate credentialing documentation for all active practitioner’s while maintaining confidentiality of practitioner information.
  • Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications.
  • Obtains, reviews, completes and audits practitioner credentialing and re-credentialing applications; contacts practitioner for additional documentation if required; monitors applications for timely approval and follow-up as needed.
  • Coordinates, compiles and prepares reports pertaining to practitioners as requested. Preparation of correspondence associated with the credentialing process.
  • Maintains knowledge of current health plans and agencies requirements for credentialing practitioners.
  • Sets up and maintains provider information in online credentialing databases and systems.
  • Ensures facility addresses and provider information is current with health plans, agencies and other entities.

Required Qualifications:

  • High School Graduate or General Education Degree (GED): Required.
  • 1 plus years of experience in customer or client service experience in the area of medical billing, credentialing, finance, account.
  • Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

NextGen Healthcare believes in strength through diversity. We are an equal opportunity workplace and an affirmative action employer supporting Diversity, Disabled, and Protected Veterans. Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, gender identity, disability or veteran status.

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Because NextGen Healthcare believes in providing a safe work environment, we conduct background checks as part of our hiring processes.

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