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Senior Credential Specialist
3 months ago
Summary:
The position of a Credential Specialist is to look after the process by which healthcare providers and professionals in an organization are granted licenses. The role entails making sure that all necessary credentials, licenses and certifications are correct, up-to-date and meet regulatory and organizational standards. You will closely work with the providers to authenticate their qualifications as well as facilitating their onboarding in order to ensure smooth operations.
Responsibilities:
- Credentialing Process Management: Look after the completion of the whole process of credentialing for new and existing providers to meet both organizational and regulatory deadlines.
- Verification of Qualifications: It is important that you carry out a comprehensive fact-check on education, training, licensure, board certifications, work history among other relevant qualifications pertinent to those working in the medical field.
- Document Management: This relates to updating all licensing documents including but not limited to licenses, certifications as well as any other credential mentioned in their profile within a database.
- Compliance Monitoring: Compliance monitoring should be done so that it meets professional standards set by regulating bodies like accreditation organizations and policies set by the organization itself.
- Communication and Coordination: You become the first point of contact for providers, working with them to get the information and documents that are needed. For example, you work with HR, legal and clinical teams to ensure that everything is in order.
- Audit Preparation: In relation to this, support is given in readiness for audits made by regulatory agencies or accreditation bodies through provision of necessary documents as well as ensuring that records are updated.
- Renewal Management: Responsibility also includes tracking credential expiration dates and proactively managing the renewal process to ensure ongoing compliance.
- Problem-Solving: This involves resolving any problems or inconsistencies relating to provider credentialing in conjunction with relevant departments and healthcare professionals.
- Reporting: On a quarterly basis generate reports on credentialing status, compliance of metrics such as total number of days taken for an application from receipt to approval across all payer sources.
- Continuous Improvement: Considering ways in which the process can be more efficient e.g., streamlining credentials, accuracy improvements through development of best practices.
Qualifications:
- Bachelor’s degree or other qualification related to healthcare administration or business administration; equivalent experience also considered.
- Previous experience working within a credentialing organization, compliance department or other aspect of healthcare administration.
- Strong attention to detail and organizational skills: This includes features such as solid details and organizational abilities.
- Excellent communication and interpersonal skills.
- Good interpersonal relations, as well as good communication skills.
- Ability to work independently and manage multiple tasks simultaneously.
- Familiarity with credentialing software and databases is a plus.
- Additionally, knowledge of credentialing software and databases would be an added advantage.
- Knowledge of healthcare regulations, accreditation standards, and compliance requirements.
- Moreover, it is essential that one has the understanding of accreditation benchmarks for health care regulations in addition to compliance needs.
Work Environment:
- Full-time position - remote work.
- Collaborative team environment with opportunities for professional growth and development.
- USD Salary.
