Credentialing Specialist

The Credential Specialist plays an essential role in ensuring the accurate and timely credentialing of healthcare providers within River Region Psychiatry Associates, its affiliated hospitals, and associated insurance payors. This position is responsible for managing the credentialing process, verifying provider credentials, maintaining compliance with regulatory standards, and facilitating relationships with external stakeholders. The Credential Specialist will leverage their expertise in credentialing, healthcare regulations, and provider relations to support the organization's mission and operational excellence.

1. Provider Credentialing and Enrollment:

• Coordinate the credentialing and recredentialing processes for healthcare providers, including psychiatrists, psychologists, and other clinical professionals.
• Review and verify provider credentials, licensure, education, training, certifications, and professional references in accordance with organizational policies and accreditation standards.

1. Compliance and Regulatory Oversight:

• Ensure adherence to state and federal regulations, accreditation requirements, and payer-specific credentialing criteria.
• Maintain up-to-date knowledge of credentialing standards, industry trends, and regulatory changes to inform best practices and compliance initiatives.

1. Stakeholder Collaboration:

• Collaborate with internal departments, affiliated hospitals, insurance payors, and external agencies to facilitate credentialing processes, resolve issues, and ensure timely provider enrollment.
• Serve as a liaison between providers, payors, and regulatory bodies to address inquiries, submissions, and credentialing-related matters.

1. Credentialing Database Management:

• Maintain accurate and comprehensive credentialing files, databases, and electronic records for healthcare providers.
• Monitor credentialing timelines, expiration dates, and recredentialing cycles to proactively address renewal requirements and compliance obligations.

1. Quality Assurance and Documentation:

• Conduct regular audits, reviews, and quality checks to validate the accuracy and completeness of credentialing data, documentation, and processes.
• Prepare and submit credentialing reports, performance metrics, and compliance documentation as required by internal policies and external stakeholders.

1. Professional Development and Training:

• Participate in ongoing professional development, training programs, and credentialing seminars to enhance knowledge, skills, and competencies in the credentialing field.
• Mentor and support credentialing staff, share expertise, and foster a culture of continuous learning and excellence within the department

POSITION QUALIFICATIONS

Education Bachelor’s degree in healthcare administration, Business, or related field; Certification in Medical Staff Services or Healthcare Credentialing is preferred.

Associates degree or certification in medical billing or related field is preferred

Experience 6 months experience in healthcare credentialing, provider enrollment, or related roles

Skills • Strong understanding of credentialing standards, healthcare regulations, and insurance payer requirements.

• Proficiency in use of Microsoft Office Programs and Credentialing software, databases, etc.