Credentialing Specialist

1 month ago

Scottsdale, United States CND Life Sciences Full time
Job DescriptionJob Description

The Credentialing Specialist (CS) at CND Life Sciences involves leading all phases of the credentialing process. This role combines expert knowledge of payer credentialing and enrollment, building policies and procedures, and best practices to direct the credentialing operations for the organization. This position is responsible for submitting accurate and complete provider and payer enrollment, physician credentialing or licensing applications, following up with relevant stakeholders, and related activities to support market access department goals.


Job Responsibilities:

  • Oversee the end-to-end technical verification and credentialing process for all new and current physicians, ensuring timely and complete processing.
  • Create and maintain an accurate credentialing database, including licenses, certifications, and malpractice insurance, and obtain primary source verifications.
  • Ensure compliance with Medical Staff Bylaws for turn-around-time in the credentialing process and follow through on initial and re-credentialing for all physicians.
  • Liaise with internal teams, such as HR, Quality, Pathology, and generate data analytics reports related to physicians and monthly quality tracking
  • Prepare and submit credentialing and re-credentialing applications to various payers, including commercial insurance companies, Medicare, Medicaid, and related agencies.
  • Maintains up-to-date knowledge of payer requirements, industry standards, and update internal processes accordingly.
  • Monitor licensing and credentialing application progress and proactively follow up to ensure timely submissions including follow-up responses.
  • Coordinates and communicates with internal departments and external entities to obtain required documentation and resolve any issues or discrepancies
  • Performs relevant data entry and maintains a technical record and regulatory compliance database with credentialing information.
  • Assist with the development and implementation of credentialing policies and procedures to enhance efficiency and accuracy.
  • Foster positive working relationships with providers, ensuring clear and effective communication throughout the credentialing process.
  • Develop and implement a comprehensive credentialing contract database to ensure accurate and efficient tracking of laboratory information.
  • Collect and organize contract data, ensuring all information is systematically recorded and maintained.
  • Create and generate reports on credentialing activities and contract statuses to support decision-making and compliance requirements.
  • Collaborate with external vendors to design database functionalities and establish streamlined data management processes.
  • Other duties assigned as needed.

Knowledge, Skills and Experience:

  • Minimum of 2 years of experience in credentialing, preferably within a laboratory, healthcare or life sciences.
  • Familiarity with credentialing requirements of regulatory bodies, insurance companies, and healthcare facilities.
  • Strong understanding of medical terminology, licenses, certifications, and privileging processes.
  • Knowledge of HIPAA regulations and healthcare compliance.
  • Demonstrated problem solving skills and adaptability to be successful in a fast-paced, results orientated, changing environment.
  • Excellent attention to detail and organizational skills.
  • Proficient in using credentialing software and databases
  • Effective communication (both verbal and written) and interpersonal skills, preferred experience working with physicians.
  • Must be reliable, responsible, and accountable for work performed.
  • Ability to work independently and as part of a team, prioritizing tasks and meeting deadlines in a multi-functional task environment.
  • Strong problem-solving and decision-making abilities.
  • Must have meticulous attention to detail, organization, and excellent time management skills.
  • The ability to handle sensitive, confidential information.
  • Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
  • Provides optimal customer service to meet the organization's expectations.
  • Ability to exercise a high degree of independent judgment in response to complex and sensitive licensing and credentialing issues, decision making and discretion.
  • Ability to use independent decision-making processes and handles assigned duties in a meaningful and confidential manner with minimal supervision.

Education, Certifications and Licensures:

  • A minimum of an associate degree in healthcare administration or a related field is required
  • Bachelor's degree in healthcare administration, business administration, or science related field (or equivalent experience) is preferred.
  • Certified Provider Credentialing Specialist (CPCS) certification a plus

Other:

  • Ability to use copiers, fax machines, and PDF scanners to keep inventory and ordering records. Visual acuity and analytical skill to distinguish sufficient detail.
  • Must possess the ability to sit or stand for long periods.
  • Must possess the ability to perform repetitive motion.

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