Job Summary: We are seeking a highly organized and detail-oriented Credentialing Specialist to join our team. The Credentialing Specialist will be responsible for ensuring that healthcare professionals comply with the necessary licensing, certification, and accreditation requirements. This role is essential in maintaining the quality and standards of our healthcare services. Responsibilities: + Analyzes and audits insurer contract agreements and reimbursement fee schedules. Presents newly and updated proposed contract agreements and proposed reimbursement fee schedules to accounting and billing management for consideration. + Maintains electronic and hard copy documentation of all insurance contract agreements and fee schedules. + Updates service item charged amount pricing as needed and reports changes to billing management. + Develops, monitors and reports insurance company compliance with contracts, including non-price terms and reimbursement rates + Attends Health Alliance and insurer seminar and training sessions as needed and reports relative material to management and staff. + Assists billing specialists in the day-to-day billing activities as needed. + Assists accounting management with year-end and projected new-year insurer budget/board information as needed. + Researches insurer related initiatives and projects when assigned, researches any insurer company news that may adversely affect the practice, and reports findings to management. + Gathers all information needed to process credentialing and reappointment applications for all providers. Thoroughly completes applications, secures signatures and routes applications to participating insurers and/or organizations. Frequent follow up activity by email and phone. + Maintains and tracks credentialing status in the computer, following through to practitioner enrollment. Informs the Practice via shared database files and email Billing and Clinical management of new approvals. + Handle insurer tours and credentialing site visits at all practice locations as required. + Using Medicare Local Coverage Determination (LCD) Guidelines, Federal Drug Administration (FDA) guidelines, (NCCN) National Comprehensive Cancer Network, as well as insurance company medical policy guidelines, review and determined if an insurance preauthorization is required for patient chemotherapy treatment regimes and obtain appropriate preauthorization. + Obtain re-authorization for continuing services before the present authorization expires. + Participate in the insurance company appeals process for denied authorizations to obtain payment. Shift: Monday - Friday 8 AM - 430 PM Pay and Benefits The pay range for this position is $20.00 - $23.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in East Syracuse,NY. Application Deadline This position is anticipated to close on Feb 17, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.