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Team Lead

3 months ago


San Antonio, United States Decypher Full time
Job DescriptionJob Description

Lead Credentialing Specialist, the Credentialing Specialist is responsible for all aspects of the credentialing for all medical professionals. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of appointments and all-time limited credentials.

Duties and Responsibilities of this Level

  • Obtains verification from primary sources for all regulatory requirements and monitors all applications assigned credentialing to provide updates to applicants and documents in the credentialing system in compliance with regulatory standards.
  • Researches and maintains current and accurate data for all providers for the Health System within the Credentialing database.
  • Verifies the legitimacy of practitioner information with the primary source of the credentials and in accordance with the accreditation regulatory standards, and state/federal laws for universities, licensing agencies, hospitals, and certification bodies.
  • Maintains a complex credentialing database with up-to-date practitioner information.
  • Maintains confidentiality of all provider information within our credentialing database, as well as documentation gathered through the credentialing process.
  • Provides credentialing and privileging verifications in accordance with regulatory standards, and state/federal laws.
  • Composes, proofreads, or edits formal correspondence, memoranda, and short reports for internal and external circulations. Assembles attachments and corresponding materials. Reviews outgoing materials for completeness, dates, and signatures.
  • Serves as a credentialing subject matter expert with internal and external contacts on the administration of the program and/or program policies and procedures.
  • Applies office standards, policies, procedures, and authority levels when responding to questions from both internal and external customers.
  • Organizes and maintains resource information and job procedures pertinent to responsibilities.
  • Prepares a variety of documents, records, reports, etc. as needed to perform job responsibilities.
  • Performs other duties as assigned.

Knowledge, Skills and Abilities

Maintains knowledge, as the Subject Matter Expert for compliance of policies and procedures. delegated credentialing contracts of current health plan and agency requirements in the managed care contracts for credentialed providers.

Minimum Qualifications

Education

Work requires analytical, communications and organizational skills generally acquired through completion of a bachelor's degree program. In lieu of bachelor's degree, four years relevant experience in Medical Staff Credentialing/Privileging (in addition to the experience requirement for the role)

Experience

One year of experience in a Medical Staff/Managed Care credentialing office. Lead Credentialing Specialist Experience: Three years of experience in a Medical Staff/Managed Care credentialing office.