Credentialing Specialist

3 weeks ago


Providence, Rhode Island, United States Brown University Health Full time

Job Summary: We are seeking a highly motivated and detail-oriented Credentialing Specialist to join our team at Brown University Health. As a Credentialing Specialist, you will play a critical role in ensuring the accuracy and completeness of provider data in our credentialing database.

Key Responsibilities:

  • Receives and audits incoming requests for enrollment and verifies provider documentation.
  • Answers phone calls and responds to inquiries from providers, practice managers, and health plans in a timely and accurate manner.
  • Handles and resolves provider complaints and inquiries via email or phone.
  • Processes customer and account source documents by reviewing data for deficiencies and resolving discrepancies.
  • Prepares source data for database entry by compiling and sorting information and establishing entry priorities.
  • Enters provider data in the requested format for uploading into the credentialing database.
  • Verifies entered customer and account data by reviewing, correcting, deleting, or reentering data.
  • Maintains provider records in the credentialing database by entering new and updated customer and account information.
  • Reports needed changes for processes and process improvement.
  • Maintains customer confidence and protects operations by keeping information confidential.
  • Maintains productivity measures and quality measures as defined by the Credentialing Department.
  • Maintains quality assurance, safety, environmental, and infection control in accordance with established system policies and procedures.

Requirements:

  • High school level of knowledge or equivalent required; associate degree preferred.
  • Proven expertise in the healthcare physician credentialing, expirables management, re-credentialing, and provider enrollment environment.
  • Highly motivated and success-driven with the ability to implement and manage cross-functional projects.
  • Proficient in Microsoft Office; knowledge of Intellicred credentialing software or other electronic credentialing systems is helpful but not required.
  • Strong organizational and excellent follow-up skills.
  • Ability to interact effectively with a variety of people (physicians and medical staff offices).
  • Provide highest level of customer service for both internal and external customers.
  • Strong written and verbal communication skills; strong presentation and client interaction skills.


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