Credentialing Specialist

2 months ago

Lawrenceburg, United States INcompass Healthcare Full time
POSITION SUMMARY

The Credentialing Specialist is responsible for overseeing and managing the credentialing and recredentialing process for healthcare providers, ensuring compliance with state, federal, and accreditation standards. This role involves verifying professional licenses, managing documentation, training, and collaboration to ensure healthcare professionals are qualified to provide client care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:
  • Maintain accurate and up-to-date credentialing files for all healthcare providers.
  • Organize and track renewal dates for licenses and certifications to ensure timely updates.
  • Ensure adherence to federal, state, and local regulations as well as organizational policies.
  • Prepare for and participate in audits related to credentialing processes.
  • Input and manage provider information in credentialing software and databases.
  • Generate reports on provider credentials and compliance status as needed.
  • Act as a liaison between healthcare providers, management, and regulatory bodies.
  • Respond to inquiries related to credentialing processes and documentation requirements.
  • Stay updated on industry best practices and changes in regulations affecting credentialing.
  • Recommend process improvements to enhance efficiency and compliance in credentialing practices, creating SOPs and providing training where needed.
  • Performs other duties as assigned.
MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
  • Required: High School diploma or GED.
  • Preferred: Bachelor's degree in healthcare administration, human resources, or a related field.
  • Preferred: One year's experience in credentialing within a healthcare setting.
  • Strong understanding of insurance plans.
  • Excellent communication and interpersonal skills.
  • Proficiency in Microsoft Office Suite
  • Ability to work effectively in a fast-paced healthcare environment.
  • Experience with EHR systems and insurance verification platforms.
  • Attention to detail
  • Strong problem-solving abilities
Our Benefits
  • Medical, Dental, and Vision Insurance
  • Prescription Coverage
  • Company Paid Life , AD&D and Disability Insurance
  • Company match up to 4.5% for 401k.
  • Generous PTO Plan, no wait period
  • Tuition Reimbursement
  • Unlimited employee referrals
  • Paid holidays

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